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HER Behavioral Health
HER Behavioral Health
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Employment Application
Intake Forms
Full Name *
Email address *
Phone Number *
City & State *
Position Applying For *
RBT
BCBA
Are you currently an RBT? *
Yes
No
BACB Certification Number *
ABA Experience *
None
Less thank 1 year
1-2 years
3+ years
Highest Level of Education *
Position Applying For *
BT
RBT
BCBA
Receptionist
Billing
Are you currently an RBT? *
Yes
No
Are you currently a BCBA? *
Yes
No
BACB Certification Number *
ABA Experience *
None
Less than 1 year
1-2 years
3+ years
Highest Level of Education *
Days Available *
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Minimum Session Commitment *
2 hours
3 hours
4 hours
Flexible (2–4 hours)
Preferred Availability *
Morning (9 AM–12 PM)
Midday (12 PM–3 PM)
After School (3 PM–6 PM)
Evening (5 PM–7 PM)
Weekend
How many hours per week are you seeking? *
Less than 10
10–15
16–20
21–30
30+
Can you consistently commit to the availability listed above for at least 6 months? *
Yes
No
Preferred Service Area *
Reliable transportation? *
Yes
No
Willing to provide community-based services? *
Yes
No
“Why would you like to join HER Behavioral Health?” *
Resume upload *
Leave this field empty
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