APPLICATION FOR EMPLOYMENT
We are an equal opportunity employer. Applicants are considered for
positions without regard to veteran status, uniformed service member
status, race, color, religion, sex, national origin, age, physical or metal
disability, genetic information or any other category protected by
applicable federal, state, or local laws.
THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW.
THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION IF HIRED,
THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR
ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE.
Position Applying For: _ABA Line Therapist
How did you hear about the position:_through website:
http://www.postjobfree.com/job/aheu58/aba-psychology-pursuing-baton-rouge-
la
Name Olson, David, Richard
Last First Middle
Maiden
Present address: 3000 July Street, apt 1213, Baton Rouge, LA, 70808
Number Street City State
Zip
Telephone (208 ) _861-4860 Email:
************@*****.***
Availability: BIG's staff works Monday - Friday. Place a check in any box
in which you are available to work. It is important that you complete the
following section.
Session: Check if
Available
8:30-3:30 X
8:30-5:30 X
Date on which you can start work if hired_2/25/15
Have you previously applied for employment with this Company? Yes
No_X
If yes, when did you
apply?
How long of a commitment can you give to working at BIG? (Please specify in
months. Please note that BIG requires a commitment of 12 months) _12+
months
Are you interested in growing in the field of ABA? Yes, I am
currently working towards my BCBA or BCABA.
Yes, I am planning on enrolling in courses to become a
BCBA or BCABA.
X__ Possibly, it is an option.
No, I have goals to pursue another career.
If no,
list the career you are pursuing.
Education School Name Graduate # of Graduatio Degree/Major Are you
? Years n Date currently
Y or N Complete enrolled?
d
High Nampa Y 4 2000 High school No
School Christian diploma
High School
Northwest Y 5 2005 B.A. No
College Nazarene Psychology
University
Post Azusa Y 3 2008 M.A. Clinical No
College Pacific Psychology
University
Education
Experience:
Describe any experience you have had working with young children (e.g.,
babysitting, camp counselor, volunteer work)
Worked as a camp counselor at Twin Rocks Friends Camp in the summer of
2004. After that, worked at Idaho Elks Rehab hospital in 2008- 2009 doing
neuro-psychological assessments with children. Also worked briefly with an
individual with autism in 2012.
Name of Supervisor: Dr. David Nilsson Phone Number: unknown: currently
retired
May we contact? Yes No X If No, why not? As he is retired, I have
not been successful in finding his number.
Describe any experience you have with persons with autism.
I briefly worked with an individual with an autistic spectrum disorder. My
work involved helping the client meet certain goals that had been set by
his counselor, his parents, and himself. This sometimes involved helping
him do homework or taking him into the community to interact with people.
Name of Supervisor: _Holle McRae Phone Number:_208-870-5955
May we contact? Yes_X No If No, why not?
Describe any experience you have with Applied Behavior Analysis (ABA).
I currently hold a certificate of completion in "Principles of Applied
Behavior Analysis," certified through Innovative Learning, LLC.
Name of Supervisor: None. Online course. Phone Number:
May we contact? Yes No If No, why not?
Work Experience:
Please list your work experience for the past five years beginning with
your most recent job held.
Name of employer: College of Western Idaho
Address: 5500 East Opportunity Drive, Nampa, ID 83687 Phone Number: 208-
562-2611
Job Title: Adjunct Faculty: Psychology Professor Pay or Salary $ 2,900.00
per course
Name of Last Supervisor: Martha Timberlake May we contact? Yes X No If
No, why not?
Employment Dates: From: Fall, 2013 To: current
Reason for leaving (be specific): Am not currently teaching, because
enrollment was down this semester and my courses were not filled.
List the jobs you held, duties performed, skills used or learned,
advancements or promotions while you worked here:
Was responsible for teaching a course in General Psychology. My duties
included creating lectures, administering and grading exams, as well as
facilitating in-class discussions.
How much notice did you give when resigning? If none, explain. As I have
not secured a full-time job yet, I have not given any notice of
resignation.
Name of employer: College of Idaho
Address: 2112 Caldwell Blvd. Caldwell, ID, 83605 Phone Number: 208-459-
5840
Job Title: Adjunct Faculty: Psychology Professor Pay or Salary $2,500.00
per course
Name of Last Supervisor: Timothy Shearon May we contact? Yes X No
If No, why not?
Employment Dates: From Fall, 2014 To: current
Reason for leaving (be specific): haven't left, but am not contracted to
teach for the Spring semester.
What will this employer say was the reason your employment was terminated?
Employment was not terminated.
List the jobs you held, duties performed, skills used or learned,
advancements or promotions while you worked here
Was responsible for teaching a course in General Psychology. My duties
included creating lectures, administering and grading exams, as well as
facilitating in-class discussions.
How much notice did you give when resigning? If none, explain. As I have
not secured a full-time job yet, I have not given any notice of
resignation.
Have you ever been terminated or asked to resign from any job? Yes No X
If yes, how many times?
Has your employment ever been terminated by mutual agreement? Yes No X
If yes, how many times?
Have you ever been given the choice to resign rather than be terminated?
Yes No X If yes, how many times?
If you answered Yes to any of the above three questions, please explain the
circumstances of each occasion.
Background Information
Have you ever been convicted of a crime? X No Yes
If yes, explain number of conviction(s), nature of offense(s) leading to
conviction(s), how recently such offense(s) was/were committed, sentence(s)
imposed, and type(s) of rehabilitation.
Professional References:
NAME POSITION COMPANY RELATIONSHIP TELEPHONE
Dr. Martha Chair, College of Supervisor 208-***-****
Timberlake Department Western
of Idaho
Psychology
Dr. Timothy Chair, College of Supervisor 208-***-****
Shearon Department Idaho
of
Psychology
APPLICANT
CERTIFICATION
I understand that the Company may now have, or may establish, a drug-free
workplace or drug and/or alcohol testing program consistent with applicable
federal, state and local law. If the Company has such a program and I am
offered a conditional offer of employment, I understand that if a pre-
employment (post-offer) drug and/or alcohol test is positive, the
employment offer may be withdrawn. I agree to work under the conditions
requiring a drug-free workplace, consistent with applicable federal, state
and local law. I also understand that all employees of the location,
pursuant to the Company's policy and federal, state, and local law, may be
subject to urinalysis and/or blood screening or other medically recognized
tests designed to detect the presence of alcohol or illegal or controlled
drugs. If employed, I understand that the taking of alcohol and/or drug
tests is a condition of continual employment and I agree to undergo alcohol
and drug testing consistent with the Company's policies and applicable
federal, state, and local law.
If employed by the Company, I understand and agree that the Company, to the
extent permitted by federal, state, and local law, may exercise its right,
without prior warning or notice, to conduct investigations of property
(including, but not limited to, files, lockers, desks, vehicles, and
computers) and, in certain circumstances, my personal property.
I understand and agree that as a condition of employment and to the extent
permitted by federal, state, and local law, I may be required to sign a
confidentiality, restrictive covenant, and/or conflict of interest
statement.
I certify that all the information on this application, my resume, or any
supporting documents I may present during any interview is and will be
complete and accurate to the best of my knowledge. I understand that any
falsification, misrepresentation, or omission of any information may result
in disqualification from consideration for employment or, if employed,
disciplinary action, up to and including immediate dismissal.
THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW.
THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED,
THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR
ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE. NOTHING IN THIS APPLICATION OR
IN ANY DOCUMENT OR STATEMENT, WRITTEN OR ORAL, SHALL LIMIT THE RIGHT TO
TERMINATE EMPLOYMENT AT-WILL. NO OFFICER, EMPLOYEE OR REPRESENTATIVE OF THE
COMPANY IS AUTHORIZED TO ENTER INTO AN AGREEMENT-EXPRESS OR IMPLIED-WITH ME
OR ANY APPLICANT FOR EMPLOYMENT FOR A SPECIFIED PERIOD OF TIME UNLESS SUCH
AN AGREEMENT IS IN A WRITTEN CONTRACT SIGNED BY THE PRESIDENT OF THE
COMPANY.
IF HIRED, I AGEE TO CONFORM TO THE RULES AND REGULATIONS OF THE COMPANY AND
I UNDERSTAND THAT THE COMPANY HAS COMPLETE DISCRETION TO MODIFY SUCH RULES
AND REGULATIONS AT ANY TIME, EXCEPT THAT IT WILL NOT MODIFY ITS POLICY OF
EMPLOYMENT AT-WILL.
I authorize the Company or its agents to confirm all statements contained
in this application and/or resume as it relates to the position I am
seeking to the extent permitted by federal, state, or local law. I agree to
complete any requisite authorization forms for the background investigation
which may be permitted by federal, state and/or local law. If applicable
and allowed by law, I will receive separate written notification regarding
the Company's intent to obtain "consumer reports."
I authorize and consent to, without reservation, any party or agency
contacted by this employer to furnish the above mentioned information. I
hereby release, discharge, and hold harmless, to the extent permitted by
federal, state, and local law, any party delivering information to the
Company or its duly authorized representative pursuant to this
authorization from any liability, claims, charges, or causes of action
which I may have as a result of the delivery or disclosure of the above
requested information. I hereby release from liability the Company and its
representative for seeking such information and all other persons,
corporations, or organizations furnishing such information. Further, if
hired, I authorize the company to provide truthful information concerning
my employment to future employers and hold the company harmless for
providing such information.
If hired by this Company, I understand that I will be required to provide
genuine documentation establishing my identity and eligibility to be
legally employed in the United States by this Company. I also understand
this Company employs only individuals who are legally eligible to work in
the United States.
THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF SIXTY (60)
DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST
REAPPLY.
I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS
APPLICATION IS TRUE, ACCURATE, AND COMPLETE.
DO NOT SIGN UNTIL YOU HAVE READ ALL OF THE INFORMATION CONTAINED IN THE
APPLICATION.
Applicant Signature_David R. Olson Date: 2/19/15