Employment Application – Davis Stuart Careers

Apply for Tri-Role Licensed Clinician (Case Mgr. / Therapist / Admin.) – Per Diem / Flexible

Complete all required fields. You can move backward before submitting your application.

Personal Information Step 1 of 7

Personal Information

First Name *

Middle Name or Initial

Last Name *

Preferred Name

Date of Birth *

Phone *

Email *

Street Address *

City *

State *

ZIP Code *

Position and Availability

Date Available to Begin

Employment Preference

Days and Shifts Available

I am available to work weekends. I am available to work holidays. I am available to work overtime when required. I am legally authorized to work in the United States. * I now or in the future will require employment sponsorship.

Education

Education 1

School Name

City and State

Degree, Diploma, or Certificate

Field of Study

Graduation Year

Work Experience

I do not have previous work experience.

Employer 1

Employer Name

Employer Phone

City and State

Job Title

Supervisor

Start Date

End Date

Responsibilities

Reason for Leaving

May We Contact This Employer?

References

Please provide professional references when possible.

Reference 1

Name

Relationship

Phone

Years Known

Qualifications

Licenses and Certifications

Special Training, Skills, or Qualifications

Additional Information

Résumé *

PDF or Microsoft Word document, up to 10 MB.

Cover Letter

Optional. PDF or Microsoft Word document, up to 10 MB.

Review and Sign

Please use the Previous button to review your answers before submitting.

Electronic Signature — Type Your Full Legal Name *

I certify that the information in this application is true and complete to the best of my knowledge. I authorize Davis Stuart to verify the employment, education, and reference information I have provided. I understand that submitting this application does not create an employment contract. *