Application for Employment

We consider applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, marital or veteran status, sexual or affectional preferences or any other legally protected status in accordance with all applicable local, federal, and state laws. If you are hired, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States.

Position(s) applying for:

Name, Contact, and General Information

Education and Work History

Business and Professional References

Name Relationship Title Phone Number Email



I certify this application was completed by me and the entries contained in this application are true and complete to the best of my knowledge. I understand that misrepresentation or omission of facts requested on this application may be grounds for rejection of this application or dismissal from employment if subsequently discovered.

I authorize an inquiry which may provide information background concerning my character, general reputation, and past work performance. I hereby authorize the company to inquire, and also authorize and request each former employer, educational institution, persons, credit bureaus, governmental and law enforcement agencies to answer all questions which may be legally asked, and to release all information which may be legally sought. I hereby release all parties from any liability or responsibility for doing so.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice. I further understand that only the CEO of the agency or another person specifically authorized by board resolution has the authority to create or enter into any employment contract on behalf of the company.

If hired, I agree to comply with all rules, regulations, and employment policies of Central Behavioral Health.