First Name

Last Name

Phone *

Email *

Which position are you applying for?

Address

State

City

Postal code

Date Available to start:

What is your availability for block scheduling (check all that apply)

B1 8:30am/9am - 12pm

B2 12:30pm/1pm - 3:30pm/4pm

B3 3:30pm/4pm - 6:30pm/7pm

Languages spoken?

How many hours a week are desired?

Are you 18 years old or older?

Yes

Have you been convicted of a felony?

Yes

Citizenship Status:

U.S. Citizen

Non-U.S. Citizen

Are you currently enrolled in Applied Behavior Analysis coursework?

Yes

What is your highest level of education?

List any licenses/certifications, skills or qualifications that are relevant to this position:

Give a brief description of your experience in the field of Behavior Analysis or working with children/adults with disabilities.

Have you been employed by Kuska Autism Services before?

Yes

Do you have any relatives/friends that work with Kuska Autism Services?

How did you hear about Kuska Autism Services?

Have you applied with Kuska Autism Services before?

Yes

Please provide 3 Professional References (can be shared after the initial interview if preferred):

Name
Relationship
Phone
Email Address

Reference 2

Name
Relationship
Phone
Email

Reference 3

Name
Relationship
Phone
Email

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By Submitting this application I give permission for my former employers to answer any and all questions based upon information available to them.

I understand that:

I may be required to submit to drug testing or medical evaluation if hired and at any time in the future and I agree to such testing. My failure to complete testing will result in the withdrawal of my application.

I am giving permission to Kuska Autism Services to conduct a background check.

Kuska Autism Services will verify the legal work authorization and identity of all new employees. I understand that an offer of employment will depend upon Kuska Autism Services' ability to verify my employment eligibility.

I understand that my failure to sign this form will be considered a withdrawal of my application for employment.

Employment with Kuska Autism Services is at will

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