BrightSpots Behavior and Learning – Employment Application

We're glad you're here. Tell us a bit about yourself and we'll be in touch — most people finish this in about 5 minutes.

This application stands in for a resume, so there's no file to upload — just the fields marked *.

💾Your answers are saved on this device as you go, so you can close this and come back.

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Personal Information

First name *

Last name *

Address (Street, City, State, Zip) *

Phone *

Email *

Are you 18 years or older? *

Yes No

Required for state board registration as a Line Technician.

Legally authorized to work in the US? *

Yes No

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Education

High School

High school *

Diploma GED Currently enrolled

A diploma or GED is required for state board registration.

Name of high school *

Graduation Date

College / University

College Status

Bachelor's Master's Currently Enrolled N/A

Name of College / University

Graduation Date

Field of Study / Major

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Work History (Most Recent First)

This is my first job — I don't have previous employment to list.

Position 1 — Most Recent

Company *

Position / title *

Dates employed *

Supervisor

Phone

Reason for Leaving

Position 2

Company

Position / Title

Dates Employed

Supervisor

Phone

Reason for Leaving

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Background & Acknowledgments

The state board requires a background check for anyone working directly with clients. It's done by fingerprint through the state police as part of your board registration — we'll walk you through it if we move forward together.

Have you ever been convicted of a crime? *

Yes No

This question comes from the state board's Line Technician registration form. A conviction does not automatically disqualify you — the board reviews each case individually.

⚙️ Physical Requirements Acknowledgment

This position may require: lifting up to 50 lbs., standing for extended periods, physical intervention techniques, and working in various environments.

Can you perform these essential functions with or without reasonable accommodation? *

Yes No

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Applicant Certification & Signature

Applicant Certification

I certify that all information provided in this application is true and complete to the best of my knowledge. I understand that false or misleading information may result in disqualification from consideration for employment, or if employed, may result in termination.

I authorize BrightSpots Behavior and Learning to verify all information provided and to contact my references and former employers.

I understand that employment is contingent upon successful completion of a background check and required training and certifications.

Printed Name *

Date *

Signature * I, (your name above), certify that the information in this application is true and complete, and I agree to the statements above. I understand that typing my name here is my electronic signature.

✅ By submitting this application, you confirm that:

All information provided is accurate and complete
You authorize BrightSpots to verify all information and contact references
You understand employment is contingent on background check completion
You understand that false information may result in disqualification or termination

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Application Submitted!

Thank you for applying to BrightSpots Behavior and Learning. Your next step is to schedule your interview — it only takes a minute.

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Schedule Your Interview

Pick a time that works for you.

Questions? Call us at (337) 739-8005 or email brightspotsbehavior@gmail.com

Join Our Team

Personal Information

Position & Availability

Education

Experience & Qualifications

Work History (Most Recent First)

Background & Acknowledgments

Applicant Certification & Signature

Application Submitted!

Schedule Your Interview