Consultation and Collaboration BCBA Consultant for South Alabama

Describe the circumstances and provide the name and address of the employer or organization where the lawsuit, investigation or allegations occurred. Explain how the lawsuit was resolved.

Describe the circumstances and provide the names and address of the employer, or organization with which you and/or the children were associated at the time of the incident. Explain how the situation was resolved.

Describe the circumstances and provide the names and address of the employer, or organization with which you associated at the time of the incident.

How did you hear about The Learning Tree?

References

Please provide three (non-family) references.

Relationship(Required)

I hear by certify that the information contained in this application form and/or any supplement thereof, is correct to the best of my knowledge; and understand that any misstatement, misrepresentation of fact or omission of information is grounds for dismissal from employment. I authorize the references listed to provide The Learning Tree, Inc. any and all information they may have regarding my previous employment or personal qualifications; and release all parties from all liability for any damage that may result from furnishing said information to The Learning Tree, Inc. I further understand that said background check may involve checking law enforcement records at the local, county, state, and federal levels. I hear by authorize The Learning Tree, Inc. to make such an inquiry, and understand that upon my written request, information as to the nature of the inquiry will be provided to the applicant.

Please Sign Name

Employment Application – Consultation and Collaboration Program Application (South Alabama)

Personal Information

High School Education

College Education

Work Experience

References