Employment - Shoreline Therapy Center

Application for Employment

The Shoreline Therapy Center is an equal opportunity employer, dedicated to a policy of nondiscrimination in employment on any basis prohibited by law. The Shoreline Therapy Center 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.

Employment

Personal Information

Name

First

Last

Street Address

Address Line 2

City

State

ZIP / Postal Code

Home Phone

Phone

Are you either a U.S. Citizen or an alien authorized to work in the United States?

Yes

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

If employment is offered, can you produce documentation required by law to establish work authorization and identity?

Yes

Position(s) applied for

On what date would you be available to work?

Are you available to work:*

Full-Time

Part-time

Hourly Rate/Salary desired?

Are you currently on “lay-off” status and subject to recall?

Yes

Can you work overtime?

Yes

Can you travel if your job requires it?

Yes

Have you ever applied to this company before, or worked for this company before?

Yes

If yes, under what name, dates of employment and department?

Do you have friends or relatives working here?

Yes

If yes, list name and relationship to you

Have you ever been dismissed, involuntarily terminated or forced to resign from employment?

Yes

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 (Write n/a if not applicable)

Graduate/ Professional/ Trade/Business | Name and address of School (Write n/a if not applicable)

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

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. List 3 total

Employer

Address

City

Country/State

Phone

Dates Worked | From - To

Job Title

Hourly Rate/Salary

Duties/Accomplishments

Supervisor (Name and Title)

Reason for Leaving

Employer

Address

City

Country/State

Phone

Dates Worked | From - To

Job Title

Hourly Rate/Salary

Duties/Accomplishments

Supervisor (Name and Title)

Reason for Leaving

Employer

Address

City

Country/State

Phone

Dates Worked | From - To

Job Title

Hourly Rate/Salary

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 | Name, Address, Home Phone, Business Phone

Reference #1

Reference #2

Reference #3

Resume (PDF)

File Upload. Accepted file types: pdf, max. file size: 10 MB

Maximum file size: 8.39MB

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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— Services —

— Locations —

Madison | Westport

Application for Employment

Personal Information

Education

Employment Experience

Skills and Experience

References

Resume (PDF)

— Services —

— Locations —

Why We’re Different?

The Connections Program

Resources