Clinical Program Director

Resume/CV, Full name, Email, Phone, Current location, Current company, LinkedIn URL

• Pronouns choose one · optional
• Legal Name and Other name(s) Include previous last names, surname aka, shortened names/name variations and nicknames. Include Legal Name if not previously provided in name field. written answer
• Street Address
• City
• State/Province choose one · optional
• Zip Code
• High School - Name, City and State
• What is your highest attained degree? choose one · optional
• Undergraduate University choose one · optional
• Undergraduate Degree and/or Coursework optional
• Masters and/or PHD University choose one · optional
• Masters and/or PHD Degree / Coursework optional
• If you are currently working towards a degree, what is your anticipated completion date? optional
• Do you know any language(s) other than English? If so, please indicate which language(s) below: written answer · optional
• Were you referred by a current Menta Employee? If so, please name: written answer · optional
• Are you over 21 years of age? choose one
• Are you willing to undergo a drug test in order to work in our school? choose one
• Are you eligible to work in the United States? choose one
• Have you ever been convicted of a criminal offense, other than a minor traffic violation (You are not obligated to disclose sealed or expunged records of convictions or arrests)**see below choose one · optional
• ** You do not need to respond to this question until after you have been selected for an interview or otherwise deemed to be qualified as a candidate for the position you are seeking. Additionally, a conviction record will not automatically result in disqualification for employment - the nature, date(s), rehabilitation, and relation to job sought will be considered. optional
• If yes, please explain and provide dates: written answer · optional
• Have you ever had any indicated finding of child abuse filed in your name? choose one
• Does your name appear on any sex offender database in any state or country? choose one
• CONSENT TO BACKGROUND CHECK: Section 10-21.9 of The School Code of the State of Illinois and A.R.S. 15-534(A) in Arizona (“Applicable School Code”) require that an applicant for employment with a school district is required, as a condition of employment, to authorize a fingerprint investigation to ascertain if the applicant has been convicted of certain criminal offenses. The Applicable School Code also stipulates that the School District perform a check on the Statewide Sex Offender Database. Should I be a candidate for employment with Special Education Services, I agree to authorize both investigations and will allow myself to be fingerprinted as a part of this investigation. Candidate may not be employed unless such investigation has been initiated. I certify that the information given by me in this application is true in all respects, and I agree that if the information given is found to be false or misleading in any way, it shall be considered sufficient cause for denial of employment or, if already hired, discharge. I authorize the use of any information in the application to verify my statement, and I authorize past employers, all references and any other person to answer all questions asked concerning my ability, character, reputation, previous employment and education record or anything else contained in this application. I expressly release all such third parties from any liability or damages on account of having furnished such information, as well as Special Education Services for seeking any verification of such information contained in this application. yes / no · optional
• [1] Employer optional
• [1] Employer Location optional
• [1] Dates Employed optional
• [1] Job Title and Duties written answer · optional
• [2] Employer optional
• [2] Employer Location optional
• [2] Dates Employed optional
• [2] Job Title and Duties written answer · optional
• [3] Employer optional
• [3] Employer Location optional
• [3] Dates Employed optional
• [3] Job Title and Duties written answer · optional
• Name, Title, Place of Employment ,Phone, Email and where you worked with Reference written answer · optional
• Name, Title, Place of Employment ,Phone, Email and where you worked with Reference written answer · optional
• Name, Title, Place of Employment ,Phone, Email and where you worked with Reference written answer · optional
• Name, Title, Place of Employment ,Phone, Email and where you worked with Reference written answer · optional
• Provide any social work or clinical license type, State of License and Status (e.g. LCSW IL Active Status) written answer · optional
• Are you a previous employee of The Menta Education Group? choose one
• Are you a current employee of The Menta Education Group? choose one