Check all that apply
List previous work experience starting with most recent. Complete all information (for a given section) and do not reference your resume.
List people, not listed in the employment section, who are knowledgeable about your work and qualifications.
I hereby affirm that the information given by me on this application for employment is complete and accurate. I understand that any falsification or omission of material facts may result in disqualification from consideration for employment; or once hired, may be grounds for immediate dismissal.
I hereby authorize the companies and individuals on this application to give you any and all information concerning my educational degrees, certifications, licenses, previous employment and any pertinent information they may have. I hereby release all parties from all liability from any damage that may result from furnishing information to Prelude Behavioral Services.
In consideration for my employment, I agree to conform to the rules and regulations of the company and my employment and compensation can be terminated, with or without cause, and with or without notice, at any time at the option of either me or the employer. I understand that no supervisor or other representative of Prelude Behavioral Services other than the CEO has any authority to enter into any agreement for any specified period of time or make any agreement contrary to the forgoing.
It is the policy of Prelude Behavioral Services to provide equal employment opportunity to all individuals regardless of their race, creed, color, religion, sex, age, national origin, disabilities, veteran status, marital status, sexual orientation, gender identity, military status, or any other characteristics protected by local, state, or federal law.
Equal Opportunity Employer Minorities/Females/Veterans/Individuals with Disabilities
In order to complete your job application, please fill out the self-identification forms below:
Our company is an Affirmative Action/Equal Employment Employer and as such, we are required to collect and maintain information related to applicants in order to meet governmental record keeping and reporting requirements and to monitor the effectiveness of our outreach, recruitment and other employment practices.
At this time, we are asking you to help us meet our obligations by providing the following information. Please note that the information will be used only in accordance with the provisions of applicable laws, executive orders, and regulations. Providing this information is voluntary and refusal to do so will not result in any adverse treatment. The information you provide will be held in strict confidence except that:
A "disabled veteran" is one of the following:
A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval, or air service.
An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
An "armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
Prelude Behavioral Services abides by the requirements of federal laws which prohibit discrimination and require affirmative action by covered prime contractors and subcontractors to employ and advance in employment qualified individuals with the following legally protected status: race, color, religion, sex, national origin (per Executive Order 11246), disability (per 41 CFR 600741.5(a)), and protected veterans (per 41 CFR 60-300.6(a)).
Please complete the self-identification of disability form below to complete your application:
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.
If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Disabilities include, but are not limited to:
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.
Form CC-305OMB Control Number 1250-0005
The following formats are recommended: PDF, DOC, DOCX, RTF, TXT, HTML. All submissions must be under 2MB.