Behavior Intervention Services St. Louis Employment Application

Employment Application

* fields are required

Employment Application

Personal Details
Name*
First Last
Preferred Pronouns*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone*
Cell Phone*
*
"I Agree". By checking this "I Agree" box and providing your telephone number above, you consent to Behavior Intervention Services sending and receiving text communication. Standard texting and messaging rates apply.
Are you at least 18 years of age?:*
* * * Anyone younger than 18 is not eligible for employment. * * *
- Yes
- No
Email*
Date Available*
MM slash DD slash YYYY
Position*
Please select a position from the list below
Seeking*
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?
MM slash DD slash YYYY
Do you have any relatives currently employed by Behavior Intervention Services?*
- Yes
- No
If Yes, please list name:
Do you understand that a background check with the Family Care Safety Registry will be conducted for all positions?*
- Yes
- No
Do you understand that a clean driving record is required in order to qualify for all positions?*
- Yes
- No
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 number 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
Beginning time of availability

: Hours

Minutes

AM/PM
Mon
End time of availability

: Hours

Minutes

AM/PM
Tues
Beginning time of availability

: Hours

Minutes

AM/PM
Tues
End time of availability

: Hours

Minutes

AM/PM
Wed
Beginning time of availability

: Hours

Minutes

AM/PM
Wed
End time of availability

: Hours

Minutes

AM/PM
Thurs
Beginning time of availability

: Hours

Minutes

AM/PM
Thurs
End time of availability

: Hours

Minutes

AM/PM
Fri
Beginning time of availability

: Hours

Minutes

AM/PM
Fri
End time of availability

: Hours

Minutes

AM/PM
Sat
Beginning time of availability

: Hours

Minutes

AM/PM
Sat
End time of availability

: Hours

Minutes

AM/PM
Sun
Beginning time of availability

: Hours

Minutes

AM/PM
Sun
End time of availability

: Hours

Minutes

AM/PM
Education
High School:*
Did you graduate?*
- Yes
- No
College
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Did you graduate?
- Yes
- No
Degree
Other Education:
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Training
Do you hold current CPR Training?
- Yes
- No
If yes, when does it expire?
MM slash DD slash YYYY
Do you hold current Medication Administration Training?
- Yes
- No
If yes, when does it expire?
MM slash DD slash YYYY
Do you hold current Mandt Systems Training?
- Yes
- No
If yes, when does it expire?
MM slash DD slash YYYY
References
Full Name*
Relationship*
Company*
Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Full Name*
Relationship*
Company*
Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Previous Employment
Employer 1*
Company:
Phone*
Position*
Start Date of Employment*
MM slash DD slash YYYY
End Date of Employment*
MM slash DD slash YYYY
Responsibilities*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor Name*
Starting Salary*
Ending Salary*
Reason for leaving*
May we contact your previous supervisor for reference?*
- Yes
- No
Employer 2
Company:
Position
Responsibilities
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor Name
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason for leaving
Starting Salary
Ending Salary
May we contact your previous supervisor for reference?
- Yes
- No
Employer 3
Company
Position
Responsibilities
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor Name
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Reason for leaving
Starting Salary
Ending Salary
May we contact your previous supervisor for reference?
- Yes
- No
Military Service
Branch
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Rank at Discharge
Other information BIS should take into consideration when reviewing your application:
Full Name*
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 75 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.
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Employment Application

Employment Application

Personal Details

Location

Availability

Education

Training

References

Previous Employment

Military Service