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BT Initial Screening Form

Behavior Technician Application & Pre-Employment Screening

Personal Information

Position & Referral

Education

Certifications & Credentials

Experience

Availability

Job Requirements

Please confirm you meet the following requirements:

Professional References

Reference 1

Reference 2

Reference 3

Signature & Authorization

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any false statements or omissions may result in disqualification from employment or termination if hired. I authorize Autism Behavioral Consultants to contact my references and verify the information provided.

Autism Behavioral Consultants  ·  140 Worcester-Providence Turnpike, Unit 4, Sutton, MA  ·  (508) 219-6009