BBHSI NEWS
PROGRAM PERFORMANCE OUTCOMES REPORT 2016

PROGRAM PERFORMANCE OUTCOMES REPORT 2016

(For 2015 Data)

Beneficial Behavioral Health Services provides a range of mental health and substance abuse services to individuals and families in Eastern Nebraska. The center provides services at one location in Omaha and in client’s homes.

● To find out more about BBHS, feel free to contact us. Our phone number is listed below, and we would love to hear from you.
● Beneficial Behavioral Health Services ("BBHS") began operations in 1999. It is a for-profit outpatient mental health agency.
   
Beneficial Behavioral Health Services – Application Form
 
PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE
 
APPLICATION FOR EMPLOYMENT
APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS
 
DATE
Last Name 
First Name 
Middle Name 
Maiden Name 
Present Address 
City 
State 
Zip 
How Long 
Social Security No. 
E-Mail Id 
Telephone 
If under 18,please list age 
Position applied for (1)
 
And salary desired (2)
Days/hours available to work (ex:09.30AM - 6.30PM)
How many hours can you work weekly?  
Can you work nights?  
Employment desired  FULL –TIME ONLY PART-TIME ONLY FULL OR PART-TIME
When available for work?  

TYPE OF SCHOOL
NAME OF SCHOOL  
LOCATION (Complete mailing address)  
NUMBER OF YEARS COMPLETED  
MAJOR AND DEGREE  
High School
College
Bus. Or Trade School
Professional School

HAVE YOU EVER BEEN CONVICTED OF A CRIME?Yes No
 
If yes, explain each offense(s) type, conviction(s) date, sentence(s) imposed, and disposition. *Please note that a conviction is not necessarily a bar to employment and will be evaluated for time since conviction, severity of offense and relationship between offense and position available.
 
 
 
DO YOU HAVE A DRIVER’S LICENSE? YesNo
What is your means of transportation to work?
 
Driver’s license
 
Number State of IssueOperator Commercial Chauffeur
Have you had any accidents during the past three years? How many?
Have you had any moving violations during the past three years?How many?
 
OFFICE ONLY
 
Typing YesNo WPM
10-keyYesNo
Word ProcessingYesNo WPM
Personal computer Yes PC
No  Mac
Other Skills
 
Please list two references other than relatives or previous employers.
 
NameName
PositionPosition
CompanyCompany
AddressAddress
Telephone ( )Telephone ( )
 

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

MILITARY SERVICE
 
HAVE YOU EVER BEEN IN THE ARMED FORCES?Yes No
ARE YOU NOW A MEMBER OF THE NATIONAL GUARD/RESERVES?Yes No
Speciality  Date Entered  Discharge Date
Work Experience Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.
 
Name of employer:
Address:
City:
State:
Zip Code:
Phone Number:
Your last job title:
Name of last
Supervisor

 

Employment Dates
 
From:
 
To:
Pay or Salary
 
Start:
 
Final:
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
 
Name of employer:
Address:
City:
State:
Zip Code:
Phone Number:
Your last job title:
Name of last
Supervisor

 

Employment Dates
 
From:
 
To:
Pay or Salary
 
Start:
 
Final:
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
 
Name of employer:
Address:
City:
State:
Zip Code:
Phone Number:
Your last job title:
Name of last
Supervisor

 

Employment Dates
 
From:
 
To:
Pay or Salary
 
Start:
 
Final:
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
 
Name of employer:
Address:
City:
State:
Zip Code:
Phone Number:
Your last job title:
Name of last
Supervisor

 

Employment Dates
 
From:
 
To:
Pay or Salary
 
Start:
 
Final:
Reason for leaving (be specific)
 
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
May we contact your present employer?Yes No
Did you complete this application yourself?Yes No
If not, who did?

PLEASE READ CAREFULLY

APPLICATION FORM WAIVER

In exchange for the consideration of my job application by Beneficial Behavioral Health Services (hereinafter called “the Company”),
I agree that:


Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Beneficial Behavioral Health Services, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President/General Manager of the Company. Both the undersigned and by Beneficial Behavioral Health Services may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.


I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.


I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.


I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.


I further understand that my employment with the company shall be probationary for a period of ninety (90) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

 

This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.

 
Thank you for completing this application form and for your interest in our business.