How did you hear of this position? *
Are you at least 18 years of age? *
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Yes
No
Are you authorized to work in the USA without sponsorship now or anytime in the future? *
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Yes
No
What is your highest level of completed education? *
Please select High School Diploma/GED
Associate's degree
Bachelor's degree
Master's degree or higher
I have none of the above.
What licensure do you currently possess? *
Please select LSW
LPC
LISW
LPCC
LISW-S
LPCC-S
I do not have any of the abovementioned licensure.
Please describe any professional experience you have working with a SUD population. *
Describe any clinical experience you have had developing trust with a client/patient. *
Have you at any time worked for Crossroads Health or any of its predecessors (e.g. Crossroads LCACS; Pathways; Neighboring)? If “Yes”, please detail the position title, your duties and the months and years of your tenure. If no, please put “No” *
Are you related to any current or former Crossroads Health or New Directions employee or Board of Directors member? Relations include, but are not limited to: spouse, child/children, parent, grandparent, sibling, aunt/uncle, in-laws, stepfamily and other persons related by blood or marriage. If the answer is “Yes”, please list who and the nature of the relationship (e.g. neighbor, friend, sister-in-law, parent etc). If the answer is “No”, please put “I know no one”. *
If you accept an offer from Crossroads Health, when would be able to start? Also, for scheduling purposes only, are you aware of any reasons to be away from work (i.e. pre-paid vacations, conferences etc) within your first 90 days? *
Have you been convicted of a felony in the last 10 years? *
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Yes
No
If you answered "Yes" to the above question, please describe the felony conviction, including dates. If you answered "No", please put "N/A" *
Were/are you a member of the U.S. Armed Forces? *
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Yes
No
If you accept a position with us, are you willing to submit to a background check that includes criminal checks,education and employment verification, a drug test, TB test and fingerprinting? *
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Yes
No
If offered a position and you accept, when would you be able to start? *
What is your minimum annual salary requirement? *
Please read the Terms and Conditions below: *
Terms and Conditions
My application for employment with Crossroads/Beacon Health/New Directions (“The Organization”) is made with the understanding that nothing contained in this application or in the granting of an interview is intended to create a contract between The Organization and myself for either employment or for the providing of any benefit. Further, if The Organization and I enter into an employment relationship, I understand that I may terminate my employment at any time and for any reason and I understand that any false information, omissions, or misrepresentations of fact called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize The Organization to obtain information concerning me from current or former employers, references, education institutions and state and federal agencies for public records including, but not limited to, motor vehicle or criminal records. I release all concerned from any liability or damage whatsoever for issuing this information. I understand that receipt of a poor reference or background check notification of a record of prior criminal activity or the failure to successfully complete a physical examination and/or drug test may prevent me from obtaining or maintaining employment.
Please select Yes, I have read and I consent to the terms and conditions My initials act as my signature.
Voluntary Self-Identification
For government reporting purposes, we ask candidates to respond to the below self-identification survey.
Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring
process or thereafter. Any information that you do provide will be recorded and maintained in a
confidential file.
As set forth in Crossroads Health ’s Equal Employment Opportunity policy,
we do not discriminate on the basis of any protected group status under any applicable law.
Gender
Please select Male
Female
Decline To Self Identify
Are you Hispanic/Latino?
Please select Yes
No
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Please identify your race
Please select American Indian or Alaskan Native
Asian
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Hispanic or Latino
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Two or More Races
Decline To Self Identify
Race & Ethnicity Definitions
If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.
As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure
the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories
is as follows:
A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.
A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
Veteran Status
Please select I am not a protected veteran
I identify as one or more of the classifications of a protected veteran
I don't wish to answer
Voluntary Self-Identification of Disability
OMB Control Number 1250-0005
Expires 04/30/2026
Why are you being asked to complete this form?
We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.
Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp .
How do you know if you have a disability?
A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:
Alcohol or other substance use disorder (not currently using drugs illegally)
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
Blind or low vision
Cancer (past or present)
Cardiovascular or heart disease
Celiac disease
Cerebral palsy
Deaf or serious difficulty hearing
Diabetes
Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
Epilepsy or other seizure disorder
Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
Intellectual or developmental disability
Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
Missing limbs or partially missing limbs
Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
Partial or complete paralysis (any cause)
Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
Short stature (dwarfism)
Traumatic brain injury
Disability Status
Please select Yes, I have a disability, or have had one in the past
No, I do not have a disability and have not had one in the past
I do not want to answer
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