BrightSpots Behavior and Learning – Employment Application

Thank you for your interest in joining BrightSpots Behavior and Learning. Please complete all sections of this application accurately and completely. False or misleading information may result in disqualification or termination of employment.

📋 ALL FIELDS MARKED * ARE REQUIRED

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Personal Information

Today's Date *

Full Name (Last, First, Middle) *

Address (Street, City, State, Zip) *

Phone *

Email *

Are you 18 years or older? *

Yes No

Legally authorized to work in the US? *

Yes No

💼

Position & Availability

Position Applied For *

How did you learn about this position?

Website Job Board Social Media Referral

If referred, who referred you?

Other (specify)

Employment Type Desired

Full-time Part-time Temporary

Salary / Wage Expectation ($)

Per

Hour Year

Available Start Date

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Education

High School

High School Status

Diploma GED Currently Enrolled

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)

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

Have you ever been convicted of a crime? *

Yes No

⚙️ 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

✍️

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 *

Applicant Signature *

Draw your signature above using mouse or touch

✅ 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

🎉

Application Submitted!

Thank you for applying to BrightSpots Behavior and Learning. We have received your application and will be in touch soon.

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

Personal Information

Position & Availability

Education

Experience & Qualifications

Work History (Most Recent First)

Background & Acknowledgments

Applicant Certification & Signature

Application Submitted!