Virtual Speech-Language Pathologist SLP

Woodstock, IL
Student Services – Speech Therapists /
Full-Time /
Remote

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Essential/Legal Questions

  • Do you know any language(s) other than English? If so, please indicate which language(s) below:
  • Were you referred by a current Menta Employee? If so, please name:
  • Are you over 21 years of age?✱
  • Are you willing to undergo a drug test in order to work in our school?✱
  • Are you eligible to work in the United States?✱
  • Have you ever been convicted of a criminal offense, other than a minor traffic violation (You are not obligated to disclose sealed or expunged records of convictions or arrests)**see below
  • ** You do not need to respond to this question until after you have been selected for an interview or otherwise deemed to be qualified as a candidate for the position you are seeking. Additionally, a conviction record will not automatically result in disqualification for employment - the nature, date(s), rehabilitation, and relation to job sought will be considered.
  • If yes, please explain and provide dates:
  • Have you ever had any indicated finding of child abuse filed in your name?✱
  • Does your name appear on any sex offender database in any state or country?✱
  • CONSENT TO BACKGROUND CHECK: Section 10-21.9 of The School Code of the State of Illinois and A.R.S. 15-534(A) in Arizona (“Applicable School Code”) require that an applicant for employment with a school district is required, as a condition of employment, to authorize a fingerprint investigation to ascertain if the applicant has been convicted of certain criminal offenses. The Applicable School Code also stipulates that the School District perform a check on the Statewide Sex Offender Database. Should I be a candidate for employment with Special Education Services, I agree to authorize both investigations and will allow myself to be fingerprinted as a part of this investigation. Candidate may not be employed unless such investigation has been initiated. I certify that the information given by me in this application is true in all respects, and I agree that if the information given is found to be false or misleading in any way, it shall be considered sufficient cause for denial of employment or, if already hired, discharge. I authorize the use of any information in the application to verify my statement, and I authorize past employers, all references and any other person to answer all questions asked concerning my ability, character, reputation, previous employment and education record or anything else contained in this application. I expressly release all such third parties from any liability or damages on account of having furnished such information, as well as Special Education Services for seeking any verification of such information contained in this application.✱

Pronouns/Legal Name/Names/Address

  • Pronouns
  • Legal Name and Other name(s) Include previous last names, surname aka, shortened names/name variations and nicknames. Include Legal Name if not previously provided in name field.✱
  • Street Address✱
  • City✱
  • State/Province✱
  • Zip Code✱

Education

  • High School - Name, City and State✱
  • What is your highest attained degree?✱
  • Undergraduate University
  • Undergraduate Degree and/or Coursework
  • Masters and/or PHD University
  • Masters and/or PHD Degree / Coursework
  • If you are currently working towards a degree, what is your anticipated completion date?

Professional License Information for Student Service Staff

  • Please provide your IDFPR License Number, Certification Type (e.g. Occupational Therapist or Speech Language Pathologist), Status (e.g. Active) and Expiration Date

Work History (Only if no resume supplied)

  • [1] Employer
  • [1] Employer Location
  • [1] Dates Employed
  • [1] Job Title and Duties
  • [2] Employer
  • [2] Employer Location
  • [2] Dates Employed
  • [2] Job Title and Duties
  • [3] Employer
  • [3] Employer Location
  • [3] Dates Employed
  • [3] Job Title and Duties

Professional References (Past or Present) Min. of 2 Required. Must contain *at least* one Supervisor.

  • Name, Title, Place of Employment ,Phone, Email and where you worked with Reference
  • Name, Title, Place of Employment ,Phone, Email and where you worked with Reference
  • Name, Title, Place of Employment ,Phone, Email and where you worked with Reference
  • Name, Title, Place of Employment ,Phone, Email and where you worked with Reference

U.S. Equal Employment Opportunity information   (Completion is voluntary and will not subject you to adverse treatment)

Our company values diversity. To ensure that we comply with reporting requirements and to learn more about how we can increase diversity in our candidate pool, we invite you to voluntarily provide demographic information in a confidential survey at the end of this application. Providing this information is optional. It will not be accessible or used in the hiring process, and has no effect on your opportunity for employment.

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