Careers

Step 1 of 10

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APPLICANT INFORMATION

Name(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

EMPLOYMENT POSITION

Position(s) Applying For:(Required)

Behavioral Health Technician

Counselor

Nursing

Administration

Other

How did you hear about this position?(Required)

What days are you available for work?(Required)

What hours or shift are you available for work?(Required)

What date can you start if hired?(Required)

Month

Day

Year

Do you have reliable transportation to and from work?(Required)

Yes

Salary desired:

PERSONAL INFORMATION

Are you 18 years of age or older?(Required)

Yes

Are you a U.S. citizen or approved to work in the U.S.?(Required)

Yes

What document can you provide as proof of citizenship or legal status?(Required)

Will you consent to a mandatory controlled substance test?(Required)

Yes

Do you have any condition which would require job accommodations?(Required)

Yes

Have you ever been convicted of a criminal offense (felony or misdemeanor)?(Required)

Yes

If yes, please state the nature of the crime(s), when/where convicted, and disposition of the case:

Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.

JOB SKILLS / QUALIFICATIONS

Please list below the skills and qualifications you possess for the position for which you are applying:(Required)

Note: NOLA Detox and Recovery Center complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.

EDUCATION & TRAINING

High School

Year Graduated

High School Location

City State / Province / Region

College / University

Year Graduated

Degree Earned

College / University Location

City State / Province / Region

Vocational School / Specialized Training

Year Graduated

Degree Earned

Vocational School / Specialized Training Location

City State / Province / Region

MILITARY

Are you a member of the Armed Services?(Required)

Yes

What branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

PREVIOUS EMPLOYMENT

Employer 1

Employer Name:

Job Title:

Supervisor Name:

Employer Phone:

Employer Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Dates Employed:

Reason for Leaving:

Employer 2

Employer Name:

Job Title:

Supervisor Name:

Employer Phone:

Employer Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Dates Employed:

Reason for Leaving:

Employer 3

Employer Name:

Job Title:

Supervisor Name:

Employer Phone:

Employer Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Dates Employed:

Reason for Leaving:

REFERENCES

Please provide 2 personal and professional reference(s) below:

Reference

Phone

Reference

Phone

ADDITIONAL INFORMATION

Will you consent to a mandatory background check?(Required)

Yes

Additional Comments (optional):

AT-WILL EMPLOYMENT

The relationship between you and NOLA Detox and Recovery Center is referred to as “employment at will.” This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or NOLA Detox and Recovery Center. No representative of NOLA Detox and Recovery Center has authority to enter into any agreement contrary to the foregoing “employment at will” relationship. You understand that your employment is “at will,” and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive VicePresident/Chief Operations Officer or the Company’s President.

Signature(Required)

Date(Required)

Month

Day

Year

Come Work With NOLA Detox

APPLICANT INFORMATION

EMPLOYMENT POSITION

PERSONAL INFORMATION

JOB SKILLS / QUALIFICATIONS

EDUCATION & TRAINING

MILITARY

PREVIOUS EMPLOYMENT

Employer 1

Employer 2

Employer 3

REFERENCES

ADDITIONAL INFORMATION

AT-WILL EMPLOYMENT

NOLA Strong. NOLA Sober. NOLA Detox.