Employment Application

* fields are required

Personal Details
Name:*
Address:*
,
Phone:*
Date of Birth:
Email:*
Cell:*
Other:
Date available:
Position Applied for:*
Seeking:*
By checking this box I acknowledge that a condition of my employment with Behavior Intervention Services I will be required to work nights and weekends:*  
Desired Salary:
SSN:*
State of Birth:
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 felony?  Yes No
If so, explain?
How did you hear about us?:
Emergency Contact:
Relationship:
Phone of Contact:

Location
How many miles are you willing to drive to work:
How long are you willing to drive to work (in minutes):

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

Other Education:
From:
To:

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:
Type of Discharge:
If other than honorable, explain:

Please check all boxes
 I understand as part of the acceptance of this position that I will be required to work weekend shifts
 I understand that my schedule may fluctuate based upon the specific needs of my client and ongoing shifts that are available, and it is my responsibility to check WhenToWork (Behavior Intervention Services' convenient online scheduling tool) to find out my schedule on any given week
 I understand that if I cannot work a shift I have been assigned, it is MY responsibility to find coverage for that shift
 I am responsible for any shifts posted on WhenToWork, whether it be an ongoing scheduled shift or an open shift
 I understand that assignment of shifts is based on seniority
 I will provide, below, any hours I absolutely CANNOT work, and the reason for not being able to work those hours. (Weekend hours may not be included in this as they are mandatory).

Resume
Upload your Resume:

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Behavior Intervention Services
10176 Corporate Square Dr. #220
Creve Coeur, MO 63132

Ph. 314-395-9375
Fax. 314-395-9381

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