Home
About
What to expect
Partnerships
Resources
Connect

Menu

Home
About
What to expect
Partnerships
Resources
Connect

Application Form

Application for Employment

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job related to medical condition or handicap, or any other legally protected status.

Step 1 of 9

11%

Today's Date(Required)

MM slash DD slash YYYY

Type of Employment Requested(Required)

Administrative

Therapist

Student

Other

Other

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Have you ever filled out an application with us before?(Required)

Yes

No

Please provide date of application

MM slash DD slash YYYY

Have you ever been employed with us before?(Required)

Yes

No

Please provide date(s) of employment

Have you ever been a student intern with us before?(Required)

Yes

No

Please provide date(s) of internship

Are you currently employed?(Required)

Yes

No

May we contact your present employer?

Yes

No

On what date are you available to begin employment?(Required)

MM slash DD slash YYYY

What days & hours are you available?(Required)

What is your pay & benefit requirement?(Required)

Can you travel if the job requires it? (Is your schedule flexible?)(Required)

Yes

No

Are you able to work evenings?(Required)

Yes

No

Have you ever been convicted of a felony? (Criminal background checks required prior to employement)(Required)

Yes

No

Please explain:

Undergraduate Education

Undergraduate School Name & Location

Degree Received

Number of Years Completed

1

2

3

4

Other

Other

Describe Course of Study

Describe any specialized training, internships, skills, and extracurricular activities.

Describe any honors you have received.

State any additional information you feel may be helpful to us in considering your application.

Graduate Education

Graduate School Name and Location

Degree Received

Number of Years Completed

1

2

3

4

Other

Describe Course of Study

Describe any specialized training, internships, skills, and extracurricular activities.

Describe any honors you have received.

State any additional information you feel may be helpful to us in considering your application.

Other Skills

Indicate any foreign languages you can speak, read, and/or write.

List any best practice models in which you are certified/trained and tell which year you received that certification/training. (You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, handicap, or other protected status.)

Community Involvement

Indicate what community committeees, volunteer activities, and/or boards you are or have been involved with in the past 5 years.

References

Name	Nature of your relationship	Address	Phone	Actions

There are no Entries.

Maximum number of entries reached.

Please add at least three references.

Employment Experience

Employer	Phone	Job Title	Dates Employed	Actions

There are no Entries.

Maximum number of entries reached.

Please add at least three previous employers.

Special Skills & Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experience.

Document Upload

Upload resume

Max. file size: 512 MB.

Upload cover letter

Max. file size: 512 MB.

Schedule an Appointment

Access My Client Portal

Locations: Avon | North Indy | Prestwick | tele locations available

Privacy Practices
Take a Tour
317.790.9396

Facebook-f Twitter Instagram Youtube Podcast Linkedin Pinterest