(* indicates required field)
Canada ------------- Afghanistan
Antigua and Barbuda
Bolivia, Plurinational State of
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Cocos (Keeling) Islands
Congo, The Democratic Republic of the
Falkland Islands (Malvinas)
French Southern Territories
Heard Island and McDonald Islands
Holy See (Vatican City State)
Iran, Islamic Republic of
Isle of Man
Korea, Democratic People's Republic of
Korea, Republic of
Lao People's Democratic Republic
Macedonia, Republic of
Micronesia, Federated States of
Moldova, Republic of
Northern Mariana Islands
Palestine, State of
Papua New Guinea
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Sint Maarten (Dutch part)
South Georgia and the South Sandwich Islands
Svalbard and Jan Mayen
Syrian Arab Republic
Tanzania, United Republic of
Trinidad and Tobago
Turks and Caicos Islands
United Arab Emirates
United States Minor Outlying Islands
Venezuela, Bolivarian Republic of
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Armed Forces Africa, Canada, Europe, Middle East
Armed Forces Americas (except Canada)
Armed Forces Pacific
District of Columbia
Northern Mariana Islands
United States Minor Outlying Islands
Please attach the following files
Please upload either a word or PDF version of your cover letter for this position.
Please upload either a word or PDF version of your current resume.
Any Additional Files:
Such as letters of recommendation, work examples, etc.
Please answer the following questions to help us better evaluate your application.
POSITION TITLE *
Please acknowledge your understanding this position may be either in Marina, Monterey or Salinas. *
-- Select One -- Acknowledged
Are you currently an Interim, Inc. employee? *
If yes to above question, desired location? (internal applicants only) *
Where did you first view this job posting? *
ARE YOU UNDER 18? *
BEST PHONE NUMBER TO USE FOR MESSAGES *
ARE YOU RELATED TO OR LIVING WITH AN INTERIM EMPLOYEE OR BOARD MEMBER? *
IF YES TO THE ABOVE, PLEASE ENTER EMPLOYEE OR BOARD MEMBER NAME:
PREVIOUSLY APPLIED TO INTERIM? *
IF YES TO THE ABOVE, PLEASE ENTER DATE & POSITION:
SALARY DESIRED: *
DO YOU HAVE A VALID DRIVER’S LICENSE? *
Please select State in which you have your Driver's License. If you do not have one, select "No Driver's License". *
DO YOU HAVE ACTIVE LIABILITY INSURANCE? *
DO YOU OWN/HAVE ACCESS TO VEHICLE? *
AVAILABLE FOR WORK : *
AVAILABLE FOR HOURS: *
DATE YOU CAN START: *
IF EMPLOYED, YOU WILL BE REQUIRED TO SUBMIT VERIFICATION OF YOUR LEGAL RIGHT TO WORK IN THE U.S. AS REFERENCED BY THE IMMIGRATION REFORM ACT OF 1986. IF EMPLOYED, CAN YOU SUBMIT VERIFICATION OF YOUR LEGAL RIGHT TO WORK IN THE UNITED STATES? *
INTERIM COMPLIES WITH THE AMERICANS WITH DISABILITIES ACT. ARE YOU ABLE TO PERFORM THE ESSENTIAL DUTIES OF THE POSITION FOR WHICH YOU ARE APPLYING, EITHER WITH OR WITHOUT REASONABLE ACCOMMODATIONS? *
IF APPLICABLE TO THE POSITION WHICH YOU ARE SEEKING, INDICATE OTHER SKILLS SUCH AS TYPING SPEED, SPECIFIC COMPUTER PROGRAM EXPERIENCE, AND LEVEL OF PROFICIENCY:
ARE YOU CURRENTLY A SMOKER (CIGARETTES OR OTHER TOBACCO PRODUCTS)? Interim is a smoke-free workplace and gives preference to the hiring of non-smokers who are qualified for open positions. Interim employees may be required to interact with residents and/or clients of their programs who are smokers. Although smoking is allowed only in designated areas, there may be the odor or scent of tobacco products present. *
DO YOU SPEAK, WRITE &/OR UNDERSTAND SPANISH? *
IF YES TO THE ABOVE, PLEASE NOTE LEVEL OF PROFICIENCY:
(Please note: No applicant will be denied employment solely on the grounds of a criminal conviction. Offense, date, circumstances, relevance to position applied for and State licensing regulations may be considered. Failure to disclose misdemeanor or felony convictions will result in termination or denial of employment. Verification of criminal record and DMV record is required for employment at Interim.)
A. Have you ever been convicted of any criminal offense? (You may omit offenses settled in juvenile court or under a welfare youth offender, misdemeanor convictions for marijuana-related offenses that are more than two years old, or convictions that have been judicially expunged, sealed or eradicated and misdemeanor convictions for which probation has been completed and the case judicially dismissed. *
B. Have you had any convictions for moving violations in the past 3 years? Have you had any convictions for driving under the influence (DUI), reckless driving or hit and run? You may omit violations that do not appear on your DMV record due to attendance at a driving class. *
If your answer to question A or B above is YES, please provide the following information: Date, Location, Offense, & Disposition
EDUCATION & TRAINING
SELECT HIGHEST GRADE COMPLETED *
-- Select One -- HIGH SCHOOL
HIGH SCHOOL DIPLOMA
INDICATE HIGH SCHOOL NAME, LOCATION & DEGREE/CERTIFICATE: *
INDICATE COLLEGE NAME, LOCATION, MAJOR SUBJECT, UNITS, & DEGREE/CERTIFICATE:
LICENSES, CERTIFICATIONS, OR PROFESSIONAL REGISTRATIONS (You may omit associations which indicate race, religious creed, color, national origin, ancestry, sex, or age.)
PLEASE INDICATE TYPE, NUMBER & EXPIRATION DATE OF ANY LICENSES, CERTIFICATIONS OR PROFESSIONAL REGISTRATIONS THAT YOU POSSESS:
PROFESSIONAL ORGANIZATIONS, SOCIETIES, MEMBERSHIPS:
List ALL of your work experience for the last 20 years, beginning with your current or most recent experience.
NOTE: In the next question, you will be asked to list hours worked per week in each position. Include all positions held, to include military service. Include volunteer services if related to this position. Experience beyond 20 years ago should be included if it is directly related to the position for which you are applying. Do not write “See Resume.” THIS SECTION MUST BE COMPLETED. Failure to follow these instructions may eliminate you from consideration for the position. *
PLEASE INDICATE THE NUMBER OF STANDARD HOURS PER WEEK YOU WORKED FOR EACH OF THE ABOVE POSITIONS: *
Have you ever been fired from a job or forced to resign? *
If you answered YES to the question above, please describe circumstances:
List below three persons who have knowledge of your work performance. These individuals should not be related to you.
REFERENCE 1 OF 3: LIST NAME, ADDRESS, OCCUPATION, TELEPHONE NO., & NUMBER OF YEARS ACQUAINTED: *
REFERENCE 2 OF 3: LIST NAME, ADDRESS, OCCUPATION, TELEPHONE NO., & NUMBER OF YEARS ACQUAINTED: *
REFERENCE 3 OF 3: LIST NAME, ADDRESS, OCCUPATION, TELEPHONE NO., & NUMBER OF YEARS ACQUAINTED: *
Please read and agree to the Disclosure Statement below. If you request any Exceptions (per the second paragraph of the Disclosure), please list below the Exception and Reason for Exception:
I would like to waive receipt of a copy of any public record described in the Disclosure Statement below.
Interim, Inc. is an equal opportunity employer.
EMPLOYMENT APPLICATION SUPPLEMENT - COUNSELOR
These supplemental questions are intended to provide detailed information about your experience related to this position.
Please describe your experience working with adults with psychiatric disabilities? *
Please describe your experience working with individuals with substance abuse problems? *
Please describe other counseling/crisis intervention experience? *
Please describe your experience working in residential treatment or in social rehabilitation programs? *
“Does your experience amount to at least one year full-time (2080 hours) working with adults with mental illnesses?” *
Please describe your experience facilitating groups; planning activities and/or recreational events? *
Please describe your experience working as a team member? *
Please describe your experience with documenting according to Medi-Cal requirements? *
Where did you hear about us? *
CSUMB (Otter Jobs)
Monterey Bay Help Wanted
Monterey Bay Jobs
I hereby 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, the undersigned applicant have personally completed this application. I understand that my omission or misstatement of material fact on this application of any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I hereby authorize Interim to thoroughly investigate, with exceptions noted below, my references, work record, education and other matters related to my suitability for employment and, further, authorize my former employers and references to disclose to Interim any and all letters, reports and other information related to my work records, without giving me prior notice of such partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgement ) be conducted by internal personnel employed by Interim Inc., I am entitled to copies of any such public records obtained by Interim, Inc. unless I mark the check box below.
I waive a receipt of a copy of any public record described in the paragraph above.
I understand that nothing contained in this application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and Interim, Inc. In addition, I understand and agree that is I am employed, my employment is for no definite or determinable period and may be terminated at any time, at the option of either myself or Interim, Inc., and that no promises or representations contrary to the foregoing are binding on Interim, Inc. unless made in writing and signed by me or my representative and Interim’s designated representative.
You will receive confirmation after we have received your application.