Employment Application First Name: Last Name: Email: Phone: Which position are you applying for? Accounting Clerk (Full-time)Administrative AssistantBehavior Specialist (Full-time)Case ManagerCommunity Integration Counselors (CIC)Day Habilitation SpecialistsDirect Care WorkerDirect Care Workers – East End of Long IslandIndependent Living Skills Trainer (ILST)Positive Behavior Intervention Specialist (PBIS)Registered NurseResidential Program ManagerResidential Assistant Program Managers Currently Employed: YesNo When can you start? Previous Employment Company: Job Title: Phone: Address: Dates of Employment: Company: Job Title: Phone: Address: Dates of Employment: Education School Name: Address: Graduated: YesNo School Name: Address: Graduated: YesNo Certifications: References Name: Occupation: Phone: Name: Occupation: Phone: Name: Occupation: Phone: We Offer Services inAll Five Boroughs of New York City! Long Island Office: 300 Kennedy Drive Hauppauge, NY 11788 Tel 631.543.2245 Fax 631.231.7558