Serving ALABAMA’S adolescents and their families regardless of ability to pay

Application For Employment

NEED ACCOMMODATIONS?

If you have a disability and need reasonable accommodations to complete this form, contact Human Resources at 256-546-6324 ext. 226 OR awinkles@bridgeinc.org

APPLICATION FOR EMPLOYMENT

The Bridge is an equal opportunity employer. The Bridge does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service or any other characteristic protected by law. Incomplete information could disqualify you from further consideration. Please complete ALL fields.

POSITION APPLYING FOR

PERSONAL INFORMATION

Name
Street or Mailing Address
Are you legally eligible for employment in the U.S?
Are you at least 18 years of age?
Have you ever been terminated from employment or asked to resign by an employer?
Can you work any shift?
Can you work overtime, including weekends?
Can you reliably commute or relocate?
Will you travel if the job requires it?
Have you ever submitted an application here before?
Have you ever been employed at The Bridge?
Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?

REFERRAL SOURCE

How did you find out about this position?

EDUCATIONAL BACKGROUND

Degree/Diploma Completed

1.

Degree/Diploma Conferred

2.

Degree/Diploma Conferred
Clinical Practicum/Internship Completed

3.

Degree/Diploma Conferred
Clinical Practicum/Internship Completed

PROFESSIONAL LICENSES AND CERTIFICATES HELD

List all professional licenses or certificates.

ADDITIONAL INFORMATION

List any additional skills, knowledge, or experience you would like to be considered in assessing your qualification for this position, such as volunteer work, vocational training, computer courses, software skills, office skills, foreign language skills, keyboarding skills/speed, research skills, etc.

TREATMENT EXPERIENCE

List the number of years experience you have in each of the categories listed below

PREVIOUS EMPLOYMENT RECORD

Beginning with your present or most recent employment, list in order all positions you have held during the past 7 years. Account for period in school, military, self-employment, unemployment, or volunteer activities. Statements such as “see résumé” do not substitute for completing any portion of this application.

1.

Address
May we contact?

2.

Address
May we contact?

3.

Address
May we contact?

PLEASE READ CAREFULLY BEFORE SIGNING

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for The Bridge to hire me. If I am hired, I understand that either The Bridge or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of The Bridge has the authority to make any assurance to the contrary. I attest with my signature below that I have given to The Bridge true and complete information on this application. No requested information has been concealed. I authorize The Bridge to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal. If I am hired, I understand that I must furnish proof of my education as indicated on my application. I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.
Applicant Name(Required)
MM slash DD slash YYYY

VOLUNTARY SELF-IDENTIFICATION (Confidential – for statistical use only)

The Bridge, Inc. is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation or any other classification protected by federal, state, or local law. The Bridge is subject to certain non-discrimination and affirmative action recordkeeping and reporting requirements to the Federal Government for civil rights enforcement purposes. For this reason, we invite you to self-identify. If you choose not to self-identify at this time, the government requires the employer to determine this information by visual survey and/or other available information. This information is kept separate from your application and will be used only in the compilation of data for EEO reporting. Completion of this data is voluntary and will not affect your opportunity for employment or terms or conditions of employment, if hired. When reported, data will not identify any specific individuals.

PLEASE COMPLETE IN FULL:

MM slash DD slash YYYY
Name
Gender
RACE/ETHNIC IDENTIFICATION (Please check one of the descriptions below corresponding to the ethnic group with which you most identify.)

Personal and Confidential

This self-identification form will be separated from the application and will not be used in the employment decision.