Employment Application
Name
*
First
Last
Email Address
*
Phone
*
Alternate Phone Number
-
Area Code
Phone Number
Region
Please Select
Bishop
Santa Clarita
Ridgecrest
Position applying for
Direct Staff
Supervisor (BCaBA or BCBA required)
Back
Next
I am over the age 18 and am legally able to work in the state of California.
*
Yes
No
I am under 18 but have a work permit
Work Permit
Browse Files
Cancel
of
Given the sensitive nature of the field of work, all of our employees must submit to a background check (live scan). I Acknowledge:
*
I do not have a criminal record and am willing to submit to a background check
I would like to discuss my past with the HR department before submitting to a background check
I am unwilling or not able to submit to a background check. I understand I will not be egible for employment.
Back
Next
Current Employment
*
Employed Full-Time
Employed Part-Time
Self-employed
Not employed, but looking for work
Homemaker
Retired
Student
Prefer Not to Answer
Place of last employment
May we contact them
Yes
No
Can we talk first
Previous employer contact info, if we can contact them
When can you start?
*
-
Month
-
Day
Year
Date Picker Icon
Back
Next
A requirement of the direct position is at least 6 months of experience with individuals with intellectual delays. Have you had 6 months experience with individuals with intellectual delays?
*
Yes
No
If you answered "Yes" to previous question, Please provide a brief description of the position and duration.
Back
Next
I have Completed Highschool with a
*
Dipolma
Certificate of Completion
GED
No, I have none of the above
Current level of education
*
Please Select
High School Graduate or Equivalent
Trade or Vocational Degree
Some College
Associate Degree
Bachelor's Degree
Graduate of Professional Degree
Prefer Not to Answer
Last school of attendance
*
Degree attained
*
Date of completion or anticipated completion
-
Month
-
Day
Year
Date Picker Icon
Back
Next
Certifications
CPR
First Aid
Nonviolent Crisis Intervention Training (NCI/NCPI)
Other
If you answered "other," please describe.
Advanced Certifications
RBT
BCaBA
BCBA
Teaching Credential
Other
RBT Number
BCaBA Number
BCBA Number
If you answered "other," please describe.
Languages fluent
*
English
Spanish
Sign language
Other
If you answered "other," please describe.
Back
Next
I have reliable transportation and able to provide proof of insurance
*
Yes
No
Salary Requirements
How did your hear about us?
Please Select
Website
Current Staff
Friend or Family
Community Event
If you answered current employee in previous question, please provide their name
First
Last
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
I am seeking
*
Part time
Full time
Part time if full time is not available
Attach Resume
Browse Files
Cancel
of
Submit
Should be Empty: