Phone: 252-641-9990

Hours of Operation: Mon - Fri (9am-5pm EST)

Weekends: By Appointment Only

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Crisis Management: 24/7/365

Employment

Positive Influences Inc.

Application For Employment

Required Trainings for Child Population

Personal Data

Full Name

Telephone

Are you a U.S. citizen or legal pemanent resident?

Yes

Date

Maiden Name

Select an Address

SSN

If not, explain your status.

General Information

What position are you applying for?

When will you be available for work?

Are you seeking full-time or part-time work?

Full-time

Part-time

Employment with Positive Influences, Inc may require physical intervention with clients who exhibit aggressive and violent behaviors. Do you have any health problems or physical limitations which would prevent you from performing physical intervention or any other tasks the position may require?

Yes

**State laws of North Carolina require that employees provide a signed physician statement verifying they are in good physical and mental health and free from communicable disease or any other condition that poses a threat to clients.

Do you know or are you related to any individuals currently employed or contracted by Positive Influences, Inc?

Yes

If so, please indicate their names.

*Have you ever been convicted of child abuse or neglect or any other offense, or forfeited a bond?

Yes

*Note: A conviction will not necessarily exclude you from employment. Factors such as age at the time of offense, rehabilitation efforts, how recent the offense, nature of the crime and type of job you are applying for will be considered.)

Education

List schools you have attended and attach transcripts for highest degree(s) obtained:

List all of the counties and states you’ve resided in over the past five years:

Skills and Training

List Dates certified and instructors for each training/certification you checked off.

Email: info@postiveinfluencesinc.com

List then email all documentation for all current licenses held:

Email: info@postiveinfluencesinc.com

List any professional associations of which you are a member:

DL License #

Chauffeur's License #

Employment History

In the space below, indicate your employment history, beginning with your current or most recent position. Include military, part-time, and significant volunteer experience. Be sure to account for all gaps in employment. If additional space is needed, please complete a supplemental sheet.

May we contact your present employer?

Yes

Most Recent Employer

Select an Address

Phone

Job Title

Work Begin Date

Work End Date (Leave blank if still working)

Supervisor

Starting/Ending Salary

Full or Part-time

Full-time

Part-time

Reason for Leaving

Job Responsibilities (be specific)

Please use the following space to provide documentation of experience with working with youth, adolescents, and adults living with a Mental Health, Developmental, or Substance Abuse disability.

Employer

Select an Address

Phone

Job Title

Work Begin Date

Work End Date

Supervisor

Starting/Ending Salary

Full or Part-time

Full-time

Part-time

Reason for Leaving

Job Responsibilities (be specific)

I certify that the information I have provided accurately represents my background and that any false or incomplete information will be grounds for rejection of my application or dismissal if I am employed by Positive Influences, Inc. I authorize Positive Influences, Inc. to obtain information about me from my previous employers, personal references and other persons or institutions listed on this application. Additionally, I authorize my pervious employers, personal references and other persons or institutions listed on this application to provide Positive Influences, Inc with any information requested, including criminal and driving record checks, if applicable. I understand any position I am offered is contingent upon receipt of a State Criminal Record check. The company may rescind any offer of employment based on the contents of this document. I understand that I must have a statement from my doctor stating that I am free of any communicable disease or a pre-employment physical stating that I am in good physical condition. I will have all trainings prior to employment and will obtain any additional required training within the first 90 days of employment. I acknowledge that this is an employment application and not an employment agreement. NOTHING HEREIN IS A PROMISE OF EMPLOYMENT FOR A FIXED TERM. IF HIRED, I UNDERSTAND THAT POSITIVE INFLUENCES, INC.MAY TERMINATE ME FOR ANY REASON OR FOR NO REASON, JUST AS I MAY RESIGN AT ANY TIME.

Thanks for submitting!

Employment

Positive Influences Inc.

Personal Data

General Information

**State laws of North Carolina require that employees provide a signed physician statement verifying they are in good physical and mental health and free from communicable disease or any other condition that poses a threat to clients.

*Note: A conviction will not necessarily exclude you from employment. Factors such as age at the time of offense, rehabilitation efforts, how recent the offense, nature of the crime and type of job you are applying for will be considered.)

Education

Skills and Training

Employment History

In the space below, indicate your employment history, beginning with your current or most recent position. Include military, part-time, and significant volunteer experience. Be sure to account for all gaps in employment. If additional space is needed, please complete a supplemental sheet.

Please use the following space to provide documentation of experience with working with youth, adolescents, and adults living with a Mental Health, Developmental, or Substance Abuse disability.

Locations

Accreditations

Links

Contact Me