Job Application - Project Mosaic

First Name *

Last Name *

Contact Number *

Email Address *

Address *

State *

Employment Position *

Crisis Stabilizer

Therapist

Mentor

Other

Desired Start Date

Salary Desired

Have you ever applied or worked for Project-Mosaic before? *

Yes

Do you have any friends, relatives or acquaintances working here now or in the past? *

Yes

Are you over 18 years of age? *

Yes

Are you a US citizen or approved to work in the US? *

Yes

Do you have a current driver’s license? *

Yes

Have you ever had your driver’s license suspended? *

Yes

Do you have auto insurance? *

Yes

Have you ever been convicted of a criminal offense (felony or misdemeanor)? *

Yes

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

Agreement

I have read and consent to the Privacy Notice.

In this document, “my personal information” includes but is not limited to my name; address; or contact information such as telephone number(s), email address(es) and residential address; educational, professional and employment history, records, certifications and information; information on memberships in organizations or political groups; and criminal records, if any; performance information and other information you provided to us.