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Extreme Counseling Solutions, Inc.

Application for Employment

Employees of Extreme Counseling and applicants for employment shall be afforded equal opportunity in all aspects of employment without regard to race, color, religion, political affiliation, national origin, disability, marital status, gender or age.
As a means of accommodation to persons with specific disabilities that prevent them from completing this application, confidential assistance in filling out this application may be obtained by calling Extreme Human Resource Dept. to which you are applying.
Elementary High School
College Post-Graduate
Yes No
1 2 3 4 5 6
Starting with the most recent, describe All paid, military and applicable voluntary experience. Highlight your knowledge, skills and abilities which best demonstrate your qualifications for this position. You may list significantly different jobs within the same organization as separate items. May we contact your present supervisor?
Yes No
Word Excel Access PowerPoint
Day Evening
Night Rotating
Weekends Specify Shift Hours
Full-time Part-time
Part-time Salaried
Yes No
During the Day During the Evening
Yes No
Yes No
Yes No
Certification (Each Application Requires Current Date and Original Signature)
Security code