Name *

First Name

Last Name

Address

Address 1

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Which Position are you interested in applying for? *

Group Facilitator

Intern

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Are you interested in *

Part Time

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Contracted

How soon would you be able to start? *

MM

DD

YYYY

Name *

First Name

Last Name

Phone *

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###

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Name *

First Name

Last Name

Phone *

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Applicant Certification & Authorization

I certify that the information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that any false, misleading, or omitted information may disqualify me from consideration for employment or, if discovered after hire, may result in termination of employment.

I authorize Clear Steps LLC to verify the information I have provided, including contacting references and reviewing criminal background records as permitted by law. I release Clear Steps LLC and any persons or organizations providing information from any liability related to such inquiries.

I understand that completion of this application does not guarantee employment. If hired, I agree to abide by all company policies, rules, and procedures.

Applicant Signature & Date *

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Date

MM

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YYYY