HBH Job Application

Hope Behavioral Healthcare - Employment Application

If you are interested in becoming an employee of HBH, please take a few minutes to complete this online application for employment. Information entered will not be saved so you need to complete and submit this form in a single session.

HBH is an outpatient behavioral health agency, an NHSC Loan Forgiveness Site and an Equal Opportunity Employer with offices in Highland and Salem, Arkansas.

AFTER COMPLETION OF ALL REQUIRED (*red) FIELDS, YOU MUST HIT THE SUBMIT BUTTON AT THE BOTTOM OF THE FORM FOR US TO RECEIVE YOUR APPLICATION

Your Name (First, Middle, Last)

Address: (city, state, zip code)

Phone Number

Email address

Today's Date

What type of Job are you interested in?

Mental Health Professional (Licensed Therapist)

Qualified Behavioral Health Provider (QBHP)

Psychiatrist/MD/APRN

Office/Clerical/Billing

Student Field Placement/Internship

What type of Schedule are you looking for?

Full-Time

Part-Time

Extra Help/Temporary

If you are a Licensed Mental Health Professional, are you interested in participating in the NHSC Loan Repayment Program?

Yes

If Yes, please select:

Full-Time

Half-Time

If you are a Licensed Mental Health Professional OR a Medical Doctor or APRN, please provide the following information:

License Type:

License Number:

Licensing Board:

Issuing State:

Has the above license (or any professional license you have held) ever been suspended, revoked, or the subject of an adverse action?

Yes

If Yes, please provide detailed information here:

For ALL APPLICANTS - Have you ever been excluded or barred from working for a Medicare or Medicaid Provider?

Yes

If Yes, please provide detailed information here:

FOR ALL APPLICANTS - Have you ever been convicted of a crime (not including misdemeanors)?

Yes

If Yes, please provide detailed information here:

FOR ALL APPLICANTS - Have you ever been required to register as a Sex Offender?

Yes

Option 3

Please tell us about your Education starting with the most recent - add as many rows as needed

+ Additional School

Please tell us about your Work/Employment History starting with the most recent - add as many rows as needed

+ Previous Job

Applicant Signature

Before you sign this application please read this statement carefully. By signing you are agreeing to the following statement:

I certify that the information given herein is true and complete to the best of my knowledge. I authorize investigation of all statements in this application as may be necessary in arriving at an employment decision. In the event of employment I understand that false or misleading information given on my application or interview(s) may result in termination of employment. HBH is an "At Will" employer. I understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with HBH is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge the Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically adknowledged in writing by an authorized representative of HBH. I understand that some of HBH's positions require special background checks, security compliance or compliance with other specific agency hiring policies prior to my employment or as a condition of employment and that failure to meet these requirements may lead to my rejection as an applicant for or termination from that position. I understand that if I am hired I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard.

By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.

Signature (typed name) of Applicant

Your information will be encrypted.