Behavioral & Educational Solutions, P.C. is an equal opportunity employer and all qualified applicants will receive consideration foremployment without regard to race, color, sexual orientation, religion, sex, national origin, marital status, disability, genetic information,past or present military service, or any other protected characteristic as outlined by federal, state and local laws.

I consent to the release, to any person of Behavioral & Educational Solutions P.C. (BES) and its Affiliates of all information that may berelevant to an evaluation of my professional qualifications, including competence, ethics and other qualifications. I release BES and theiremployees and agents from any liability for their acts performed in good faith and without malice in obtaining information and evaluating myapplication. I understand and agree that my relationship with BES is as a self-employed independent contractor and that my completion ofthis application is in no way a guarantee of any amount or specific type of work. I attest with my signature below that I have given BES andits Affiliates true and complete information on this application. No requested information has been concealed. I authorize BES to contactreferences provided for employment reference checks. If any information I have provided is untrue, or if I have concealed materialinformation, I understand that this will constitute cause for the denial of employment or immediate dismissal.