Janz Family Therapy Inc. Job Application Form
Please answer the questions below so that the company can learn more about you and build an employment profile. You can email your resumes to Heather@JanzTherapy.com

Janz Family Therapy Inc. will consider qualified applicants with criminal histories in a manner consistent with the California Fair Chance Act.

We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Please inform this employer if you need any accommodations. (Hire may be subject to passing a medical examination, and to skill and agility tests)

We may refuse to hire relatives of present employees if doing so could result in actual or potential problems in supervision, security, safety, or morale, or if doing so could create conflicts of interest.

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Email *
Name *
First, Middle, and Last Name (we require middle name if you have one)
Please enter your date of birth (MM/DD/YEAR *
Social Security Number (for background check purposes- may be given over the phone if preferred)
Phone number *
Please provide your mailing address: *
Are you 18 years or older? *
Is there any information we would need about your name or use of another name to be able to check your work record? (if yes, please specify)
Please list your Education, including institutions and month and year of graduation. If this is already on your resume, write "N/A": *
Please list your licenses and/or certifications and license number: *
Are there any pending or current legal issues that may affect your licensing status or your ability to perform as a mental health therapist?
Do you have any U.S. Military Service? *
Which position(s) are you interested in? *
Required
Are you applying for a full-time position, part-time position, or temporary position? *
What is your desired hourly pay rate? Note, we pay the same rate for both clinical and admin hours at this time.  *
What is your preferred start date? *
MM
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DD
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Are you authorized to work in the U.S.? *
How did you hear about this job?
Who is your previous employer and what is your reason for leaving? *
Please list a contact person and phone number at your previous employer:
Do we have permission to contact your previous employer? *
Please list at least two professional references below, who we would have permission to contact. List their name, title, company, phone number/email and number of years you have known them. If this is already on your resume, write "See Resume" *
Is there anything else you would like us to know? This question is optional.
By typing your name and date below, you certify this statement:  I understand that the employer follows an employment-at-will policy, in that I or the employer may terminate my employment any time, or for any reason consistent with applicable state or federal law. I understand that this application is not a contract of employment. I understand that to be employed I must be lawfully authorized to work in the United States, and I must show the employer documents that will prove this if I am offered the job. I understand that the company will thoroughly investigate my work, personal, and criminal history and verify all data given on the application, on related papers, and in interviews. I authorize all individuals, schools and firms named within to provide any information requested about me, and I release them from all liability for damage in providing this information. I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment. *
A copy of your responses will be emailed to the address you provided.
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