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Employment Application

Mental & Behavioral Health Services — Equal Opportunity Employer. Please complete all sections carefully.

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Personal Position Education Licenses Experience History Documents Sign & Submit

Applicant Information

Please provide your personal contact details as they appear on your legal documents.

Personal Details

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Valid email required

Preferred Contact Method *

Select all that apply so we can reach you.

Position Information

Tell us about the role you are applying for and your availability.

Position Applying For

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Select Position Type *

Employment Details

Please select a future date

Days Available *

Shift Availability *

Education

Provide your educational background beginning with the most recent degree.

High School / GED

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Required

College / University

Graduate / Professional Education

Professional Licenses & Credentials

List all current professional licenses, certifications, and behavioral health credentials.

Primary License / Credential

Additional Credentials & Training

Behavioral Health Experience

Help us understand your clinical background and areas of expertise.

Years of Experience *

Areas of Experience *

Medicaid / Government-Funded Experience

Employment History & References

List your two most recent employers and three professional references.

Most Recent Employer

Previous Employer

Professional References

Please provide three professional references. Do not list family members.

Employment & Credentialing Disclosures

Document Uploads

Upload supporting documents. Accepted formats: PDF, JPG, PNG. Max 10 MB per file.

Note: Documents are transmitted securely. All uploaded files are stored on our private server and used only for employment screening purposes.

Driver's License / Government ID (Required for driving roles)

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Driver's License or Government-issued ID

Professional License / Credential

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Professional license(s), certification(s)

Resume / CV *

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Resume or Curriculum Vitae (PDF, DOC, DOCX)

Additional Documents (Optional)

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Transcripts, certificates, references, or other relevant documents

Applicant Statement & Signature

Please read the statement below carefully, then sign and submit your application.

Applicant Statement

I certify that the information provided in this employment application is true and complete to the best of my knowledge. I understand that providing materially false or misleading information or intentionally omitting information requested in this application may affect my eligibility for employment or, if discovered after employment begins, may result in disciplinary action up to and including termination, subject to applicable law.

I authorize the company to verify information contained in this application as permitted by applicable law. I understand that employment may be contingent upon verification of qualifications, licenses, certifications, references, and other requirements applicable to the position.

I understand that completing this application does not constitute an employment contract or guarantee of employment.
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Signature *

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Verification

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Application Submitted!

Thank you for applying to Texas Integrated Health Systems. We have received your application and will be in touch within 5–7 business days. Please check your email for a confirmation.

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