Early Strides

Job Questionnaire

Please complete this form and submit it with your application. *Please answer all questions

First Name *

Last Name *

Phone Number *

Email *

1. Did someone refer you?

A. Yes

B. No

2. If yes, who?

5. Do you have a smart phone and are you willing to use it for time keeping purposes?

A. Yes

B. No

6. Do you have access to a computer and are you willing to use it for work related tasks?

A. Yes

B. No

8. Are you willing to be a sub until full time or Part time work is available?

A. Yes

B. No

9. Are you willing to work in any LAUSD School?

A. Yes

B. No

11. Are you comfortable working with all of the following behaviors? (Hitting, Kicking, Yelling, Biting, Scratching, Eloping, Self- injurious behaviors?)

A. Yes

B. No

12. Explain your work experience with the following behaviors. (Hitting, Kicking, Yelling, Biting, Scratching, Eloping, Self- injurious behaviors?)

13. Are you N-CPI trained?

A. Yes

B. No

16. We provide services in the following regions within LAUSD (West LA, East LA, Central LA, South, Northeast, Southeast). Do you agree to commute to all regions within LAUSD?

A. Yes

B. No

17. Regions (preferred to work in) *

West LA

East LA

Central LA

South

Northeast

Southeast

Availability:

18. Monday: Times that I am available to work *

19. Tuesday: Times that I am available to work *

20. Wednesday: Times that I am available to work *

21. Thursday: Times that I am available to work *

22. Friday: Times that I am available to work *

23. Print Full Name: *

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