Apply to Join the Team – Foundations in Behavior

1About You

2Availability

3Education

4Employment

5Personal References

6Medicaid Providers

7Conclusion

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Confirm Email

What languages are you fluent in?

English
Spanish
French
Other

What positions are you interested in applying for? *

Behavior Technician
Behavior Assistant
Behavior Analyst
Direct Support Provider (DSP, Group Home)
Other

How did you hear about Foundations?

What date will you be available to start? *

What days are you available to work? *

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

What time slots are you available to work?

Mornings (6am - 9am)
Late Morning (9am - Noon)
Afternoon (Noon - 3pm)
Early Evenings (3pm - 6pm)
Evenings (6pm - 9pm)

What is your present degree (or highest education level)? *

School Attended

School Name *

School Location

Enrollment/Start Date

Graduation/End Date

Company *

Title/Position *

Supervisor Name *

First

Last

Start Date

End Date

Job Responsibilities

Describe your job responsibilities in this role.

Reason for Leaving

Why did you leave this role/position with this organization?

Is it okay to contact this employer?

It is OK to contact this employer for a reference/verification.

Reference A

Name *

First

Last

Company

Phone *

Relationship to You *

Reference B

Name *

First

Last

Company

Phone *

Relationship to You *

Are you an approved provider of service with Florida Medicaid? *

Yes, I have a provider ID
I am not sure, but I think so
No, I have not worked with them before

If you've worked with Medicaid or Medicaid clients before through another agency, you may already have an existing ID number.

Thank you for applying to Foundations in Behavior (Foundations).
By clicking Submit My Application to Foundations in Behavior, I consent for Foundations to review the information contained and verify its accuracy. I understand that by falsifying information on this application, I will no longer be eligible to work with Foundations. My signature below provides this consent.

Eligibility *
I have NOT been convicted of a felony
I am a Citizen of the United States
I am Eligible to work in the United States
Please select all options that are true.

Signature of Consent *
Your signature verifies the information contained in this application is honest and true.

Thank you for your interest in joining Team Foundations.

School Attended

Reference A

Reference B

407.440-0500

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