• Application for Employment

    Application for Employment

    Community Support Services, Inc.

  • 01 Personal Information

  • Date of Application*
     - -
  • Are you know by any other names?*
  • Format: (000) 000-0000.

  • Are you currently authorized to work in the United States?*
  • Are you 18 years of age or older?*
  • Have you ever been the subject of a Protective Services Investigation where substantiated charges of abuse or neglect? *

  • A yes answer will not automatically bar you from consideration. It depends on the type of substantiated charge.

  • Do you have a valid driver's license or state-issued ID card?*
  • Do you have three or more years of driving experience?*
  • How did you learn about us?*
  • Have you ever been employed by us?*

  • 02 Position

  • After reviewing the DSP 1 job description, can you perform the essential functions of the job?*
  • Date Available to Start:*
     - -
  • Employment Desired (Check all that apply)*
  • Desired Shifts (Check all that apply)*
  • Will you be able to complete our pre-service training Monday through Friday for approximately one month, which will consist of both classroom training and site observation?*
  • Your current employment status*
  • May we contact your current employer?*

  • 03 Education & Experience

  • Highest Level of Education Completed*
  • Do you have experience personally or professionally working with people who have intellectual or developmental disabilities?*

  • 04 Employment History

    Start with your current or most recent job. List your last four (4) jobs in order. DO NOT LEAVE OUT ANY JOB.
  • Format: (000) 000-0000.
  • Start Date*
     - -
  • End Date*
     - -
  • May we contact this employer?*
    • Add Employer #2 
    • Format: (000) 000-0000.
    • Start Date
       - -
    • End Date
       - -
    • May we contact this employer?
    • Add Employer #3 
    • Format: (000) 000-0000.
    • Start Date
       - -
    • End Date
       - -
    • May we contact this employer?
    • Add Employer #4 
    • Format: (000) 000-0000.
    • Start Date
       - -
    • End Date
       - -
    • May we contact this employer?

  • 05 References

    List three non-relative individuals not otherwise listed who are familiar with your qualifications and actual work history and ability.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • 06 Applicant Statement

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  • READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING THIS APPLICATION. ONLY THOSE APPLICATIONS THAT ARE COMPLETE, SIGNED, AND DATED ARE CONSIDERED PLEASE VALID. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE ASK BEFORE SIGNING.

    I certify that all answers and statements I have made on this application (and resume or other materials) are true and complete without omissions. I understand that any false information will be grounds for refusal to hire or for immediate discharge if I am employed. I authorize, without reservation, any of the persons named in this application, any law enforcement agency, administrator, state agency, institution, insurance company or agent for this organization, information service or service bureau, or employer contacted by Community Support Services, Inc. to give you complete information and records regarding my employment, education, character, motor vehicle operation history, and qualifications.

  • I understand that a criminal records check WILL be conducted on me.*
  • I further acknowledge that a telephonic facsimile (fax) or photographic copy of documents shall be as valid as the original. This release incudes all federal and state agencies.*
  • I understand that if I am hired, my employment will be on an at-will basis. I recognize that if I am hired, my employment can be terminated at any time, with or without notice, for any reason not prohibited by law *

  • INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED

     

    I have read, understand, and agree with the above.

  • Date*
     - -
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