Date *

MM

DD

YYYY

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

(###)

###

####

Do you give Autism Intervention Milwaukee, LLC (AIM) permission to send texts to your mobile phone? *

Yes

No

Do you have a high school diploma or equivalent? *

Yes

No

Are you bilingual? *

Yes

No

Do you have experience with kids in a caregiver role?

Yes

No

Do you have experience working with children with disabilities?

Yes

No

Do you have experience working with children with autistic spectrum disorder?

Yes

No

Do you have legal authorization to work in the United States? *

Yes

No

Do you have a valid driver’s license? *

Yes

No

Do you have your own personal transportation? *

Yes

No

Can you provide documentation of current auto insurance coverage? *

Yes

No

Our therapy staff teach critical social communication skills to children who are often just learning to speak and may be apt to mimic dysfluency and general speaking errors. Thus, our in-home therapy positions require fully fluent and articulate mastery of the English language and the ability to communicate effectively. Can you perform these essential job functions? *

Yes

No

Our in-home therapy positions require a great deal of patience, love, flexibility, firmness, and perseverance. While children with autism are generally sweet, energetic, fun children, some autistic children have significant self-care and/or behavioral needs, particularly during periods of frustration. Thus, our staff must be psychologically prepared for the possibility of challenging behavior. This could include crying, tantrums, kicking, hitting, biting, lack of cooperation, child’s attempts at self-injury, bathrooming accidents, etc. Can you perform these essential job functions?

Yes

No

Our in-home therapy positions require the ability to bend, sit on low surfaces (such as a child-sized chair and the floor), engage in outdoor and gross and fine motor play, and lift the child as needed (weights that could range from 30-60+ pounds). Can you perform these essential job functions?

Yes

No