Careers

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Application for Employment


First Name *
Last Name *
Email Address *
Address *
City *
Cellphone Number *
State *
Home Telephone Number
Zip Code *
Business Telephone Number
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Position Information


Behavioral Health Paraprofessional
Behavioral Health Paraprofessional
Behavioral Health Technician
Behavioral Health Technician
Salary Desired
0 75000
Date you can start work? *

Check all that you are willing to work *

Part Time
Full Time
Days
Evenings
Regular
Temporary
Swing
Weekends
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Background Information


Do you have a High School Diploma or GED?*
Yes
No
Are you authorized to work in the U.S. on an unrestricted basis? *
Yes
No
Not Sure
Have you ever been convicted of a felony?
(Convictions will NOT disqualify an applicant for employment.)
*
Yes
No
If Yes, Please explain:
Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functions of the job? *
Yes
No
Can you perform these essential functions of the job with or without reasonable accommodation?*
Yes
No
Not Sure
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Qualifications Information


Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training.

School Name *
School Name
Other
Degree *
Degree
Degree
Address/City/State *
Address/City/State
Address/City/State
List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc)

Please list three professional references not related to you, with full name, address, and phone number.
If you don’t have three professional references, then list personal, unrelated references.

Full Name *
Full Name *
Full Name *
Address/City/State *
Address/City/State *
Address/City/State *
Phone Number *
Phone Number *
Phone Number *
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Work History Information


Start with your present or most recent employment and work back.
(INCLUDE PAID AND UNPAID POSITIONS)

Job Title #1
Company Name
City
Duties
Start Date
Supervisor’s Name
State
Starting Salary
End Date
Phone Number
Zip Code
Ending Salary

Job Title #2
Company Name
City
Duties
Start Date
Supervisor’s Name
State
Starting Salary
End Date
Phone Number
Zip Code
Ending Salary

Job Title #3
Company Name
City
Duties
Start Date
Supervisor’s Name
State
Starting Salary
End Date
Phone Number
Zip Code
Ending Salary

Notes, remarks, etc.
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Digital Signature *
I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application.
I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.
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Peoples Health Care Connection
Location
PHCC
3055 N 1st Ave
Tucson, AZ 85719
Office Hours
  • Mon – Fri
    8 am – 5 pm
  • Sat – Sun
    Closed
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