Application Form

Today's Date(Required)

MM slash DD slash YYYY

Type of Employment Requested(Required)

Administrative

Therapist

Student

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

Please provide date of application

MM slash DD slash YYYY

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

Yes

Please provide date(s) of employment

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

Yes

Please provide date(s) of internship

Are you currently employed?(Required)

Yes

May we contact your present employer?

Yes

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

Are you able to work evenings?(Required)

Yes

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

Yes

Please explain:

Undergraduate Education

Undergraduate School Name & Location

Degree Received

Number of Years Completed

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

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.

How did you hear about the position and what made you want to apply?

Please read our mission statement and comment on your thoughts about it.

Click here to read our mission statement.

How does this role fit into your long term goals?

Share about your experience working with people with different backgrounds or beliefs than you.

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Students Only

What are you hoping to learn while a student at Care to Change?

Write about your background working with families &/or in an administrative role?

Write about any evidence-based models you’re trained in or other certifications you have?

What skills/experience do you have that will compliment or add to our team?

What is the start and end/date?

What days/hours are you available?

Application for Employment

Undergraduate Education

Graduate Education

Other Skills

Community Involvement

Special Skills & Qualifications

Document Upload

Section Break

Students Only