Integrated Development Services, LLC.

Application for Behavior Technician

Last Name	*
First Name	*
Email address	*
Phone number	*
Address	*
City	*
State / Province	*	- - Choose One - - - - US States - - AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY - - Canada Provinces - - AB BC MB NB NL NT NS NU ON PE QC SK YT
Zip / Postal	*
Are you 18 years or older?	*	Yes No
How did you hear about IDS?	*	College Posting Career Fair College Class Indeed Craigslist Facebook Newspaper Current Employee autismtherapistjobs.com WEAU Other
If referred to IDS by a current employee please provide referring employee's name.
Have you or a family member received services from IDS past or present?	*	Yes No
Have you worked for IDS in the past?	*	Yes No
Do you have experience working with children with Autism Spectrum Disorders?	*	Yes No
If you answered yes, please describe your experiences.
Please specify highest level of education completed	*	High School Some college Bachelor's Degree Master's Degree Doctorate
Provide names of schools attended	*
List major(s)
Graduation or expected graduation date
Most recent or current employer	*
Phone number	*
Email	*
Dates of employment	*
Position held	*
Current Pay Rate	*
Reason for terminating employment
May we contact your recent or current employer?	*	Yes No
If no, please explain
Please check availability for Monday		AM 8-12 Mid day 12-3 PM 3-8
Please check availability for Tuesday		AM 8-12 Mid Day 12-3 PM 3-8
Please check availability for Wednesday		AM 8-12 Mid Day 12-3 PM 3-8
Please check availability for Thursday		AM 8-12 Mid Day 12-3 PM 3-8
Please check availability for Friday		AM 8-12 Mid day 12-3 PM 3-8
Please check availability for Saturday		AM 8-12 Mid day 12-3 PM 3-6
Please provide any additional information about your availability:
Please check the number of hours you are interested in working each week.	*	9-15 16-25 26-32 32+
When are you available to begin training?	*
What cities/locations are you applying for?	*
What is your main method of transportation?	*	Personal Vehicle Public Transportation
Have you been convicted of a felony within the last five years?	*	Yes No
If yes, please explain.
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigations of all statements and references contained herein and I authorize the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and I release the company from any liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. I also consent to a criminal background check conducted by Integrated Development Services, LLC. I understand that if I am hired by Integrated Development Services, LLC. our employment relationship will be terminable at will, which means that either myself or Integrated Development Services, LLC. may terminate my employment at any time and for any reason."
	*	I agree I disagree