Employment Application

* fields are required


Personal Details

Name:*
Address:*
,
Primary Phone:*
Cell Phone:*
Are you at least 18 years of age?:  Yes No
Email:*
Date available:
Position:*
If "Other", please specify:
Desired Salary:
Are you a citizen of United States?*  Yes No
If not, are you authorized to work in the U.S.?  Yes No
Have you ever worked for this company?*  Yes No
If so, when?
Have you ever been convicted of a misdemeanor or felony?*  Yes No
If so, explain?
Have you been convicted of a DWI within the past 7 years?*  Yes No
If yes, what year?
Do you possess a current and valid driver's license?*  Yes No
Do you possess current and valid driver's insurance?*  Yes No
Do you understand that due to the nature of employment with Behavior Intervention Services you must be willing/able to transport BIS clients in your personal vehicle?*  Yes No
How did you hear about us?:
Emergency Contact:*
Relationship:*
Phone of Contact:*

Location

In which area(s) are you willing to work:  MO St. Louis City (North City, South City)
 MO Mid County (University City, Richmond Heights, Clayton, Kirkwood)
 MO North County (Bridgeton, St. Ann, Hazelwood, Florissant, Ferguson)
 MO West County (Creve Coeur, Ballwin, Chesterfield, Ellisville)
 MO South County (Crestwood, Fenton, Affton, Lemay, Rockhill)
 MO St. Charles County (St. Charles, St. Peters, O'Fallon)
 MO Jefferson County (High Ridge, Arnold, Imperial, Festus)
 IL (Edwardsville, SAFB, Collinsville, O'Fallon)

Eligibility for employment is determined not only by experience and education but also by an applicant's ability to work in areas and during times that are currently vacant/unassigned. The areas and availability provided on this application will be a deciding factor in an offer of employment. Scheduling of day, start/end times, and shifts will be provided based on the availability listed below:

Availability

(Only write in the times that you are AVAILABLE and WILLING to work)
(Please remember that you will be required to work nights and weekends)

Mon: Fri:
Tues: Sat:
Wed: Sun:
Thurs:

Education

High School:*
Did you graduate?  Yes No

College:
From:
To:
Did you graduate?  Yes No
Degree:

Other Education:
From:
To:

Training

Do you hold current CPR Training?  Yes No
If yes, when does it expire?
Do you hold current Medication Administration Training?  Yes No
If yes, when does it expire?
Do you hold current MANDT Administration Training?  Yes No
If yes, when does it expire?

References

Full Name:*
Relationship:*
Company:*
Phone:*
Address:

Full Name:*
Relationship:*
Company:*
Phone:*
Address:

Previous Employment

Employer 1
Company:*
Phone:*
Position:*
Responsibilities:*
Address:
Supervisor Name:*
From:
To:
Reason for leaving:*
Starting Salary:*
Ending Salary:*
May we contact your previous supervisor for reference? Yes No

Employer 2
Company:
Position:
Responsibilities:
Phone:
Address:
Supervisor Name:
From:
To:
Reason for leaving:
Starting Salary:
Ending Salary:
May we contact your previous supervisor for reference? Yes No

Employer 3
Company:
Position:
Responsibilities:
Phone:
Address:
Supervisor Name:
From:
To:
Reason for leaving:
Starting Salary:
Ending Salary:
May we contact your previous supervisor for reference? Yes No

Military Service

Branch:
From:
To:
Rank at Discharge:

Other information BIS should take into consideration when reviewing your application:

By placing your full name in the box below, you are stating that you fully understand and agree to the following information:

A career with Behavior Intervention Services requires an individual to have the ability to work evenings and weekends, stand unaided for up to 5 hours, and be able to lift up to 50 pounds. The nature of our career opportunities also bring with them the requirement that employees must possess a valid driver’s license and current insurance. They must show proof of owning a safe and reliable vehicle, which they will utilize to transport clients into the community. Clients whom you may be called upon to support have a history of aggressive and/or erratic behaviors.

To the best of your knowledge, all information provided on this application is true and correct. Should false information be found prior to or during your employment at Behavior Intervention Services could result in ineligibility for or termination of employment

Full Name:*

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Our Services
Founded in 2004, Behavior Intervention Services provides a variety of services, including:
  • Behavior Assessment and Therapy across all environments
  • Personal Care Services
  • Community Integration
  • Parent and Staff Training
  • Discrete Trial Training
  • Individualized Supported Living Services
  • Individual and Family Counseling
  • August 22, 2014 – Behavior Management 1&2
    9:00 am, Training