1.800.345.1780    |    Contact Us Contact Us

home about us services employment giving ID/DD

Employment Application

Beacon Light Behavioral Health Systems is an Equal Opportunity Employer and prohibits discrimination on the basis of race, color, religious creed, disability, ancestry, national origin, age or sex.

Application To:
     
        Select From:
Application Date:

Personal Information:
Last Name: First: Middle: Telephone Number:
     
Street: City: State, Zip: Best Time to Contact:
School Address (if applicable): City: State, Zip: School Telephone:
Are you at least 21 years of age?
Per regulation, applicants must be at least 21 years of age to be employed as a direct care worker with Children's Center for Treatment and Education.		 If hired, can you present evidence of U.S. citizenship or your legal right to work in this country?


Position Desired: How did you learn of the opening?
Other:		 Referred by:



Other:

Have you ever been employed by this agency? Month/Year: Position:
If hired, you will be required to submit for Child Abuse Clearance, as well as a Criminal History Record Check. Certain felony crimes preclude individuals from being hired into a position with our agency. Have you ever been convicted of a felony crime? If YES, describe in full:
 

Education:
School: Years School Name: City/State: Degree/Major: Graduate?
High School:
(specify GED)
College:
Graduate:
Other:
Military Experience (please list branch of service, highest rank attained, length of service, specialty and/or training received)
   

Experience:
Employer 1 Employer 2
May we contact? May we contact?
If no, why? If no, why?
Name: Name:
Address: Address:
Phone: Phone:
Dates: Dates:
Title: Title:
Immediate Supervisor: Immediate Supervisor:
Beginning Salary: Beginning Salary:
Ending Salary: Ending Salary:
Reason for Leaving: Reason for Leaving:
Employer 3 Employer 4
May we contact? May we contact?
If no, why? If no, why?
Name: Name:
Address: Address:
Phone: Phone:
Dates: Dates:
Title: Title:
Immediate Supervisor: Immediate Supervisor:
Beginning Salary: Beginning Salary:
Ending Salary: Ending Salary:
Reason for Leaving: Reason for Leaving:
 
I am seeking:

Indicate date(s) available:
 I am available for:
If Part-Time, indicate maximum hours
per week: 		Shift preferred:

Additional Comments:
 

References
List four persons, not related to you, who have known you for at least one year:
Name & Address: Telephone: Years Known:
By submitting this application, I certify that answers given herin are true and complete to the best of my knowledge. I authorize investiagation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employmnent shall be considered active for a period of time not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period will need to submit a new application.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any writing by an authorized executive of this organization.

I authorize Beacon Light Behavioral Health Systems to obtain information about me from my previous employers(s), and school(s) attended. I also authorize my previous employer(s) and school(s) attended to disclose to Beacon Light Behavioral Health Systems such information as may be requested about me, including but not limited to, copies of evaluations and transcripts, and any information regarding disciplinary actions and notations regarding performance issues. I further authorize Beacon Light Behavioral Health Systems to conduct background checks including drug screening and criminal background checks as may be necessary.

I release my former schools and employers from any liability associated with furnishing Beacon Light Behavioral Health Systems information as specified above.

In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. I understand, also, that I am required to abide by rules and regulations of the employer.
     
Date:

This Section To Be Completed Only By Those Applicants Applying For nly By Those Applicants Applying For
Child Care/Counselor Positions.
Background: (How do you feel about the way you were raised?  Would you raise your children similarly?)
 
Goals: (What are your professional goals and how do you see this position meeting these goals?)
   
Skills: (Do you have any particular skills which could be incorporated into work with adolescents
            - arts/crafts, sports, outdoor skills, group leadership, driving, etc.?)
     
EXPERIENCE: (Particular notice should be given to your paid or volunteer work in a people-helping capacity. Please outline your responsibilities.)
Date: Applicant's Signature (type name)

 

Please review ALL entries on this application before clicking the submit button!

Please enter the text below and then click "submit" only once. 


You will be taken to a confirmation page once your application has been received.

website design by protocol 80