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Vista Center for Behavior Analysis Employment Application (2025) 
Vista provides in-home behavior therapy to children, adolescents, and adults with autism and other related developmental disabilities. 

QUESTIONS? Please contact our Recruiting Department at careers@vistacba.com
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TODAY'S DATE  *
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First and Last Name *
Pronouns *
Street Address *
City, State, Zip Code
 *
Phone Number - (000) 000-0000
 *
Email Address *
What position are you applying for? *
Areas you can work?  *
Required
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? (Note: We comply with federal and state disability rights laws and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination and skill and agility tests.) *
If no, describe the functions that cannot be performed, or N/A. *
Are you at least 18 years old?  *
If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this county? *
If hired, would you have a reliable means of transportation to commute between clients? *
Do you have a valid California Driver's License? *
What is the highest level of education you have completed? *
Please provide the school name and graduation date for the answer above.
 *
How did you hear about Vista?  *
Have you ever applied to or worked for our company before?
 *
Do you have any friends or relatives working for our company? *
Are you bilingual? If so, what language(s)?
 *
Has your professional license/certification ever been suspended or revoked? *
Are you currently out on bail or released on your own recognizance pending trial? (Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, date of the offense, the surrounding circumstances, and the relevance of the offense to the position(s) applied for may, however, be considered.) *
GENERAL INFORMATION
When are you available to start? *
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Requested hours per week:  *
PLEASE READ - Clinical Staff Availability/Peak Hours: 

Vista requires staff to be available for peak hours on weekdays between 3:00PM-8:00PM as we work after school. 

Earlier hours may be available, depending on location. 

During Summer Break, Winter Break, and school holidays, Vista is able to offer extended hours between 9:00AM-8:00PM.
Vista requires staff to be available for peak hours on weekdays between 3:00PM-8:00PM. 

Are you available between 3-00PM-8:00PM on weekdays? *
Please select the times you are available. More information can be provided during your interview. *
9:00AM - 3:00PM
3:00PM - 6:00PM
6:00PM - 8:00PM
UNAVAILABLE
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
Please let us know if you have any planned upcoming time off. *
What is your requested hourly rate? *
EMPLOYMENT HISTORY (Employer 1)
List below all present and past employment, starting with your most recent employer. We need at least three previous employers or employment going back at least 7 years, assuming you have worked that long.
Company Name and Job Title *
Location
 *
Dates Employed (MM/YY - MM/YY)
 *
Supervisor's Name & Contact Info
 *
What is your reason for leaving? *
May we contact this employer?
 *
EMPLOYMENT HISTORY (Employer 2)
List below all present and past employment, starting with your most recent employer. We need at least three previous employers or employment going back at least 7 years, assuming you have worked that long.
Company Name and Job Title *
Location
 *
Dates Employed (MM/YY - MM/YY) *
Supervisor's Name and Contact Info
 *
What is your reason for leaving? *
May we contact this employer?
 *
EMPLOYMENT HISTORY (Employer 3)
List below all present and past employment, starting with your most recent employer. We need at least three previous employers or employment going back at least 7 years, assuming you have worked that long.
Company Name and Job Title *
Location
 *
Dates Employed (MM/YY - MM/YY) *
Supervisor's Name and Contact Info
 *
What is your reason for leaving?  *
May we contact this employer? *
UNEMPLOYMENT DATES: 
Explain any periods/dates of unemployment during the past 7 years.
 *
PLEASE READ CAREFULLY: INITIAL & DATE EACH PARAGRAPH, AND SIGN BELOW.
I certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission or misstatement of fact on this application or on any documents used to obtain employment will be grounds for rejection of this application or for immediate termination if I am employer, no matter when discovered. *
I authorize the Company to thoroughly investigate my references, work record, education, and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any all letters, reports, and other information related to my work records, without giving me notice of such disclosure. In addition, I release the Company, my former employers and all other persons, corporations, partnerships, and associations from liability arising out of or in any way related to such investigation or disclosure. In addition, I release the Company, my former employers, and all other persons, corporations, partnerships, and associations from liability arising out of or in any way related to such investigation or disclosure. *
I understand that nothing contained in the application, or conveyed during any interview that may be granted, or during my employment if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is "at will", is for no definite time period, and may be terminated at any time, with or without notice, at the option of either myself or the Company, and that no other promises or representations regarding this subject are binding on the Company unless made in writing and signed by me and an officer of the Company. *
Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien, or outstanding judgment) be conducted by internal personnel employed by the Company, I am entitled to copies of any such public records obtained by the Company unless I mark the check box below. If I am not hired because of such information, I am entitled to a copy of any such records even though I have checked the box below. *
I waive a receipt of a copy of any public record described in the paragraph above.
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APPLICANT SIGNATURE 
By electronically signing below, you certify that the information provided on this application is true.
Signature & Date  *
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