Employment Application To apply, please fill out our employment application and submit with a cover letter, resume and salary history. Step 1 of 4 25% Position You Are Applying For*Mental Health Clinician/LCSW Preferred - Canon CityGeneral Employment ApplicationDesired Salary RangeDate Available for Work* PERSONAL INFORMATIONName* First Last Email* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone*Cell PhoneSocial Security Number*Are you a U.S. Citizen?*YesNoHave you ever been convicted of a Felony?*YesNoIf selected for employment are you willing to submit to a pre-employment drug screening test?*YesNo EDUCATIONHigh School or GED*School NameLocation Graduate or Post GraduateSchool NameLocationDates AttendedDegree ReceivedMajor Certifications or Licenses Held EMPLOYMENTEnter previous employers below, starting with the most recent.Employer 1*EmployerDates employedAddressPhonePosition HeldSupervisorSalary Employer 2*EmployerDates employedAddressPhonePosition HeldSupervisorSalary Employer 3*EmployerDates employedAddressPhonePosition HeldSupervisorSalary Additional EmployersEmployerDates employedAddressPhonePosition HeldSupervisorSalary REFERENCESReference 1*NameTitleCompanyPhone Reference 2*NameTitleCompanyPhone Reference 3*NameTitleCompanyPhone Additonal ReferencesNameTitleCompanyPhone Your DocumentsUpload Drop files here or Accepted file types: pdf, doc, docx, rtf, txt, gdoc. Upload your cover letter and resume. In order to select both files at the same time, they need to be in the same directory.Allowed formats: pdf,doc,docx,rtf,txt,gdocACKNOWLEDGEMENT AND AUTHORIZATIONHave you ever been sanctioned, terminated or excluded from and federally funded program?*YesNoPlease ExplainHave you ever been involuntarily terminated from a federal program in this state or any other state?*YesNoPlease ExplainHave you ever been involved in an administrative repayment situation?*YesNoPlease ExplainAuthorization* I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. Discharge Clause* In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. Submit Application* Upon submitting this form, I certify that all answers given herein are true and complete to the best of my knowledge.