BI – Social Skills Application - The Behaviour Change Clinic

Behaviour Interventionist - Social Skills Groups Application Form

Name

Address

Phone Number

What is your highest level of education?

High school Postgraduate/Professional certificate/diploma Undergraduate degree Masters degree

Do you have any relevant certifications or training in behaviour management, child development, or autism?

Do you have an up to date criminal record check?

Please list any additional qualifications or relevant experience you have

Describe any previous experience working with children with diverse needs

What motivates you to work with children with social, emotional, and behavioural difficulties?

Which position would you like to apply for?

Summer camp (July 2-12, 2024) After school groups (Wednesdays, Cloverdale, 3:30-5:30pm)

Are you able to commit to a consistent schedule for the duration of the program (typically 4-5 weeks)?

What skills and attributes do you possess that would make you a strong candidate for this position?

How do you respond to challenging behaviours or situations with children with diverse needs?

What is your hourly rate expectation?

Do you drive and have your own vehicle?

Yes No

Do you have business insurance on your vehicle?

Yes No

Are you willing to use your vehicle to transport children on outings (summer camp only)?

Yes No

Reference #1

Reference #2

Empowering positive change through evidence-based and neuro-affirming practices

Name