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Recovery Assistant

Group Facilitator / Counselor / Recovery Coach

    Your Information

    First Name*:
    Last Name*:
    Email*:
    Phone Number:
    Current Address:





    Projected Start Date (of current year):
    Availability:

    Current Employment

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    Are you currently employed?YesNo
    If you are currently employed, may we contact your employer?YesNo
    Current Employer & Contact Information:


    Position Information

    Which Position Are You Applying For*:
    How did you hear about this position? (check all that apply):ARC NewsletterFacebook or other social media postingRecruitment SiteGoogle SearchWord of mouth (please specify who told you about the position in the "other" line" belowOther
    If other:

    CARES Certification / Education

    Are you CARES Certified?:YesNo
    What is your highest level of education (provide all degrees, certifications, and/or licensures):

    CARES Eligibility

    do you meet CARES eligibility requirements

    Do you have a high school diploma or GED*?YesNo

    Professional References

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    Reference 1 Name*:
    Reference 1 Email*:
    Reference 1 Phone*:

     

    Reference 2 Name*:
    Reference 2 Email*:
    Reference 2 Phone*:

    Personal References

    please provide one (1)

    Name*:
    Email*:
    Phone*:

     

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