Behavioral Health Apprenticeship RSVP Form
Partner Data Sharing Referral Source
First Name
Last Name
Preferred Name
Pronouns
Please select...
He/Him
She/Her
They/Them
He/They
She/They
Not Listed
Contact #
Email
Mailing City
Mailing Zip
Resume
Cover Letter
Regions Available for Work
City
Zip Code
Demographic Information
What communities or populations do you belong to or have served? (Select all that apply)
Black or African American
Hispanic or Latino/a/x
Native American or Alaska Native
Asian
Native Hawaiian or Pacific Islander
White
Queer
Gay
Lesbian
Bisexual
Pansexual
Straight
Asexual
Questioning Sexuality
Refugees
Immigrant
Women
Men
Non-binary
Genderfluid
Trans
Intersex
2 Spirit
Young Adults (18-25)
Youth (13-25)
Adolescent Youth (1-12)
Foster Youth
Seniors (65+)
Unhoused / Homeless
DV Survivors
Christian
Muslim
Hindu
Buddhist
Re-Entry/Justice Involved
Recovery Community
Sober Living Community
Single Parenting
Communities w/ Disabilities
Food Insecure
What skills, certifications or lived experience apply to you? ( Check all that apply)
Communication (verbal/written, public speaking, counseling)
Case Notes or Documentation
Teamwork and collaboration
Experience with Re-Entry programs
Experience with Sober Living Homes
Experience serving geriatric patients/clients
Technical skills (computer programs, data entry, EMR systems, etc.)
Crisis De-escalation or conflict resolution
CNA / Nursing Assistant Certification
HCA CPC (Certified Peer Counselor)
NAADAC / SUDP-T credentials
First Aid / CPR /BLS/ Mental Health First Aid
Behavioral Health Training
Lived experience with behavioral health challenges
Lived experience navigating addiction recovery
Lived experience navigating In Patient BH Recovery Services
Lived experience Navigating Outpatient BH Recovery Services
Lived experience navigating housing insecurity
Lived experience navigating food insecurity
Experience as a caregiver or support system for family/friends with behavioral health needs
Experience in community outreach or advocacy
Multicultural or multilingual background
Experience in recovery programs or peer support
Volunteer or community service experience
Previous work in healthcare or social services
Education Degree in Psychology, Behavioral Health, Social Services or any related Program
Other
Please specify
Background & Experience
Have you attended a Behavioral Health Apprenticeship Information Session?
Please select...
Yes
No
I would like to attend one
I'm not sure
If yes, what date did you attend?
Personal Narrative
Application Status
Position Interested
Nursing Assistant Certification
Pharmacy Technician
Medical Assistant
Sterile Processing
Behavioral Health Tech
Peer Support Specialist
Substance Use Disorder Professional
Intro to Healthcare Apprenticeship
Employer(s) Interested
Do you agree to allow TRAC Associates to share your information with employer partners?
Please select...
Yes
No
Do you agree to allow TRAC Associates to send you texts? (Optional)
Please select...
Yes
No
Attestation
By completing this form, I attest that I am at least 18 years old and possess a High School Diploma or GED.
Older than 18
True
Has High School Diploma or GED
True
Campaign ID
Zoom Link
Start Date
Contact Information