Employment

COURAGE. CONNECTION. CHANGE.

Application for Employment

Shoreline Psychotherapy and Behavioral Health is an equal opportunity employer, dedicated to a policy of nondiscrimination in employment on any basis prohibited by law. Shoreline Psychotherapy and Behavioral Health considers applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation or any other legally protected status.

Personal Information
Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home Phone*
Work Phone
Are you either a U.S. Citizen or an alien authorized to work in the United States?*
- Yes
- No
If your authorization to work in the United States is subject to expiration, when will it expire?
Are you prevented from lawfully becoming employed in this country because of VISA or immigration status?*
- Yes
- No
If employment is offered, can you produce documentation required by law to establish work authorization and identity?*
- Yes
- No
Employment Desired
Position(s) applied for:*
On what date would you be available to work?*
Are you available to work:*
Hourly Rate/Salary desired?:*
Are you currently on “lay-off” status and subject to recall?*
- Yes
- No
Can you work overtime?*
- Yes
- No
Can you travel if your job requires it?
- Yes
- No
Have you ever applied to this company before, or worked for this company before?*
- Yes
- No
If yes, under what name, dates of employment and department?
Do you have friends or relatives working here?*
- Yes
- No
If yes, list name and relationship to you:
Have you ever been dismissed, involuntarily terminated or forced to resign from employment?*
- Yes
- No
If yes, please explain:
Education
High School: Name and address of High School | Years completed 9,10,11,12 Diploma*
College: Name and address of College | Years completed 1,2,3,4 Degree*
Please include your Course of Study too. Write n/a if not applicable.
Graduate/ Professional/ Trade/Business | Name and address of School*
Please include your Course of Study too. Write n/a if not applicable.
Scholastic Average at each University*
Academic Scholarships/Awards
Branch of Military
Rank at Discharge
Characterization of Discharge
Period of Active Duty:

From dates to dates...
Describe any specialized training, apprenticeship, computer skills and extra-curricular activities.
Employment Experience
Start with your present or last job. Include any job-related military service assignments and volunteer activities. List 3 total
Employer
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Dates Worked | From - To
Hourly Rate/Salary
Job Title
Duties/Accomplishments
Supervisor (Name and Title)
Reason for Leaving
Employer
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Dates Worked | From - To
Hourly Rate/Salary
Job Title
Duties/Accomplishments
Supervisor (Name and Title)
Reason for Leaving
Employer
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Dates Worked | To - From
Hourly Rate/Salary
Job Title
Duties Accomplishments
Supervisor (Name and Title)
Reason for Leaving
Skills and Experience
List pertinent licensure or certifications:*
How would you describe your personality?
Do you prefer working with a team or individually? Please explain:*
If you are a therapist what theories do you practice from:
What makes you stand out candidate for hire?
What professional trainings have you attended?*
Please provide any pertinent information that you would like us to know:
References
Please provide 3 references
Reference #1*
Name, Address, Home Phone, Business Phone
Reference #2*
Name, Address, Home Phone, Business Phone
Reference #3*
Name, Address, Home Phone, Business Phone
Resume (PDF)
Drop files here or

Accepted file types: pdf, Max. file size: 50 MB, Max. files: 4.
Applicant Agreement*
I understand that false or misleading information given in my application, resumes, interview(s) or during my employment may result in withdrawal of a job offer or discipline up to and including termination of employment, whenever the omission or falsehood is discovered. I understand that acceptance for employment shall depend on satisfactory replies from my references and other background checks. In the event I receive a job offer, I also understand that I may be subject to a drug test and/or a medical examination that I must pass before I commence work. I have read, understood and agree to the foregoing.
I certify that the answers given in this application are true to the best of my knowledge.

I understand that the use of this application form does not indicate that there are any positions open and does not in any way obligate Shoreline Psychotherapy and Behavioral Health.

I have read, understood and agree to the foregoing.
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COURAGE. CONNECTION. CHANGE.

Application for Employment

Personal Information

Employment Desired

Education

Employment Experience

Skills and Experience

References

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COURAGE. CONNECTION. CHANGE.

Application for Employment

Personal Information

Employment Desired

Education

Employment Experience

Skills and Experience

References

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