APPLICATION FOR EMPLOYMENT

Date */**/**

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:

acoei2@r.postjobfree.com

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

Contact this candidate