Application

Essential Behavioral Health Services, Inc. Employment

Use the online application to apply for open positions at Essential Behavioral Health Services, Inc. You can also download the application.

Employment Application

Non-Discrimination Policy: Essential Behavioral Health Services Inc. (EBHS) is committed to the principle of equal opportunity in education and employment. EBHS does not discriminate on the basis of sex, race, color, creed, national origin, age, religion, sexual orientation, gender identity, gender expression, veteran status, or disability in admission to, access to, treatment in, or employment in its programs and activities.


 

GENERAL INFORMATION

Date:

Position(s) Applied For:

Referral Source:

 
 

Name:
  

Address:
  , 

Phone:
 Cell Phone

Email

Are you currently employed?

If yes, may we contact your employer?

Employment desired:

When are you available for work?

Can you travel if a job requires it?  
 

EDUCATION

TYPE OF SCHOOL NAME OF SCHOOL LOCATION
(Complete mailing address)
NUMBER OF YEARS COMPLETED MAJOR & DEGREE
High School
College
Graduate School
Bus. or Trade School
Professional School

Additional Education:

Special Honors:

COMPUTER SKILLS
Check those computer skills with which you are proficient (any version)

(please list below if 'other')

PROFESSIONAL LICENSE
Do you have a current license?

Professional license number:

State of issue:   Expiration date:

MILITARY
Are you a veteran of the United States military service?   If yes, what branch?
If yes, Date Entered:   Date Discharged:
If yes, please describe any special skills or training acquired while in the service:

OTHER SPECIAL SKILLS
Please list other special skills you may have, e.g., fluency in other languages, licenses, special training required for the position for which you are applying, etc.

WORK EXPERIENCE
Please list your work experience beginning with your most recent job. If you were self-employed, give firm name. Exclude organization names which indicate race, color, creed, national origin, age, religion, sexual orientation, gender identity, gender expression, veteran status, or disability.

Most Recent Employer
Dates Employed
From: 
To:      
Work Performed
Address
Supervisor
Job Title
Reason for Leaving
Employer
Dates Employed
From: 
To:      
Work Performed
Address
Supervisor
Job Title
Reason for Leaving
Employer
Dates Employed
From: 
To:      
Work Performed
Address
Supervisor
Job Title
Reason for Leaving
Employer
Dates Employed
From: 
To:      
Work Performed
Address
Supervisor
Job Title
Reason for Leaving

REFERENCES
Please list two references other than relatives or previous employers.

Name:         

Position:      

Company:   

Address:     

Telephone:

 
 
Name:         

Position:      

Company:   

Address:     

Telephone:

 

Additional Items: (optional)
Please attach any additional items that you want to be considered with your application. Up to 3 documents. (Ex. professional certificates, recommendation letters, additional work experience, etc.)

Acceptable file types .doc, .docx, .pdf, .jpeg, .jpg - Files must not be larger than 4MB per file
 



 

WAIVERS AND DISCLOSURES

Please read each section carefully and check where indicated.

AT-WILL EMPLOYMENT

It is my understanding that this employment application, or the granting of an oral interview, does not represent a contract of employment or a promise of future benefits by this organization. I understand and agree that, if hired; my employment will be at-will in nature and may be terminated, with or without cause, at any time, by either myself or my employer. I also understand that this written statement supersedes any and all oral representations made by agents or representatives of this organization.

CERTIFICATION OF TRUTH AND ACCURACY

I certify that the information in this application is true, complete and correct. I understand that false answers, statements, or significant omissions made by me on this form shall be sufficient cause for denial of employment or discharge.

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