Behavioral Health 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


Check all that you are willing to work *

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Background Information


If Yes, Please explain:
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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
Supervisor’s Name
State
Starting Salary
Phone Number
Zip Code
Ending Salary

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

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

Notes, remarks, etc.
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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
Information
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