Apply for Direct Support Professional / Residential Counselor - Milford

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:Direct Support Professional / Residential Counselor - Milford
ID:5642
Department:Milford Road - 3100
Salary Range:$13.75/hour
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Department (Internal Only):
Application Information
* Source:
Attachments
Resume:
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  - or Upload from:
 
Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
Application for Employment (PA)
PERSONAL INFORMATION
* Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment):
Yes   No
* Are you at least 18 years or older?:
Yes   No
* Have you ever worked for this Company before?:
Yes   No
If Yes, please provide details (Where/When/Job Title):
List any friends or relative currently employed by CareLink:
* Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?:
Yes   No
If no, please explain:
* Have you ever been dismissed from employment due to abuse of a client?:
Yes   No
If yes, please explain:
* Have you ever been convicted of a felony?:
Yes   No
If yes, please explain::
* Have you been a resident of your current state/commonwealth for two or more years?:

EMPLOYMENT DESIRED
* When would you be available to begin work?:
* Type of employment desired:
Full-Time
Part Time
Full-Time or Part-Time
* Days of the week available (All full-time positions require at least one weekend day):
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
* Shift(s) Available:
1st Shift (6AM - 2PM, 7AM - 3PM, 8AM - 4PM)
2nd Shift (2PM - 10PM, 3PM - 11PM, 4PM - 12AM)
3rd Shift (10PM - 6AM, 11PM - 7AM - 12AM - 8AM)
PRN (As needed)
Any Shift
* Hourly rate/salary desired:
* Are you currently employed?:
Yes   No
If so may we inquire of your present employer?:
Yes   No
If presently employed, why are you considering leaving?:

EDUCATION
Give record of all High Schools/GED, Colleges, Universities and Vocational/Technical Schools you have attended. If entering a GED, please write "GED" in the school name field as well as the degree received.

School Name & Location Did you Graduate? Degree Received Subjects Studied/Major
*
*
Yes   No
*
Yes   No
Yes   No

If you have completed any special courses, seminars and/or training that would help you to perform the position for which you are applying, please describe (CPR/First Aid, CNA, CPRP, Certified Peer Specialist)::

EMPLOYMENT HISTORY
Give your full employment record, starting with your current or most recent employment

EMPLOYER 1

Dates Employed Employer Name & Address Employer Phone
From:
*

To:
*
*

*
*
Job Title Supervisor Name & Title May we Contact?
*
*

*
*
Yes
No
Responsibilities Reason for Leaving Salary/Hourly Rate
*
*
Start:

End:

EMPLOYER 2

Dates Employed Employer Name & Address Employer Phone
From:

To:

Job Title Supervisor Name & Title May we Contact?

Yes
No
Responsibilities Reason for Leaving Salary/Hourly Rate
Start:

End:

EMPLOYER 3

Dates Employed Employer Name & Address Employer Phone
From:

To:

Job Title Supervisor Name & Title May we Contact?

Yes
No
Responsibilities Reason for Leaving Salary/Hourly Rate
Start:

End:

MOTOR VEHICLE REPORT Driving on agency business may be a condition of your employment. CareLink has a motor vehicle incident report run on all employees to make certain that they have a safe driving record and can be covered under CareLink's auto insurance policy. Incidents appearing on a motor vehicle report are not a bar to employment in all cases; however, applicants must provide CareLink with complete and accurate information at the time of application for employment.

* Do you currently have a valid driver's license?:
Yes   No
* Is a court case regarding your license currently pending?:
Yes   No
If yes, please explain:
* Is there any reason you would not be insurable under our auto policy?:
Yes   No
If yes, please explain:
* Have you received any moving violations or been involved in any collisions within the past six (6) months?:
Yes   No
If yes, please explain:

AUTHORIZATION
The facts set forth in this application and any supplemental information are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be considered sufficient cause for immediate discharge. I hereby authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my employment, and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the company to hire me. If I am hired, I understand that either the company or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of the company has the authority to make any assurance to the contrary.

I understand that I am required to abide by all rules and regulations of the company.

* Signature (type name):
* Date:
Pre-Screening - Residential Counselor
Thank you for your interest in our openings for the position of Residential Counselor.  Please tell us a little bit about why you would like to work for CareLink?
If currently employed, why are you leaving your job?
What do you know about mental illness and the abilities or limitations of those who live with mental illness?
Please list specific tasks you worked on or goals you have achieved when working with an individual you were assigned to.  Please provide details that show how you accomplished the task or goal.
What are some of the other responsibilities you have been given?
How far are you willing to commute for this position?
* Do you have reliable transportation?
Yes
No
Professional Reference Form
Please give at least three professional references. Please be sure to include their name and a valid telephone number.
PROFESSIONAL REFERENCE 1
* Name:
* Title:
* Company:
* Relationship to Applicant:
Address:
* Telephone Number:

PROFESSIONAL REFERENCE 2
* Name:
* Title:
* Company:
* Relationship to Applicant:
Address:
* Telephone Number:

PROFESSIONAL REFERENCE 3
* Name:
* Title:
* Company:
* Relationship to Applicant:
Address:
* Telephone Number:

PROFESSIONAL REFERENCE 4
Name:
Title:
Company:
Relationship to Applicant:
Address:
Telephone Number:

Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The Information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender:
Female
Male
I Choose Not to Respond
Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond
Veteran Status: (Please check all that apply)
Individual with a Disability
An individual with a disability is a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, or who has a record of such impairment.
Vietnam Era Veteran
A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred - a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5,1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
Disabled Veteran
1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability
War/Campaign/Expedition Veteran
A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized
Armed Forces Service Medal Veteran
A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty
Recently Separated Veteran
Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.
I Choose Not to Respond

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