Kaler Residential Services Application
Please Fill Out the Form Below to Submit Your Job Application, and we will reach out to you to schedule an interview shortly!
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Name
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First Name
Last Name
Wage based on inputs (Hidden)
E-mail
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example@example.com
Phone Number
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Format: (000) 000-0000.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you currently have a valid Washington State Driver's License?
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Yes
No
License #:
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Expiration Date
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-
Month
-
Day
Year
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Have you ever applied to work at The Kaler House, Inc. or Kaler Residential Services before?
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Yes
No
When?
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Do you have any friends and/or relatives who currently work at The Kaler House, Inc., or Kaler Residential Services?
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Yes
No
State name & relationship:
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Availability
Please select all ranges you are interested in:
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Full time
Temporary
Part Time
Fill-in/On-Call
Please specify dates of availabilty
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Specify # of hours per week
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Note: Days or shifts you choose may not be available. Your flexibility increases your hiring opportunities.
Please select all days of the week you are able to work
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Please select all shifts you are willing to work
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Day Shift
Swing Shift
Graveyard Shift
If hired, what date would you be able to start work?
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-
Month
-
Day
Year
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All employees are required to pass a background check.
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State briefly why you would like to work for this agency:
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Please describe any experience, training, qualifications or skills that you feel make you especially suited for work at this agency:
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Which of these options best describes your experience relevant to being a Direct Support Professional:
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0-1 years of experience
1-3 years of experience
3-7 years of experience
7-10+ years of experience
Do you have regular access to a safe vehicle?
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Yes
No
Do you have current vehicle insurance in your name?
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Yes
No
Have you had more than -3- moving violations in the past -3- years?
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Yes
No
Do you have a current FIRST AID/CPR card?
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Yes
No
Do you have a current Food Handler’s Permit?
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Yes
No
Have you had a T.B.(Tuberculosis) test in the past year?
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Yes
No
Are you at least 21 years of age?
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Yes
No
Do you have a high school diploma and/or GED?
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Yes
No
Do you need 1163 training?
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Yes
No
Do you have a NAR/NAC?
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Yes
No
Please specify:
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Do you have relevant management experience (detail in employment history)?
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Yes
No
Do you have therapeutic options, CPI, positive behavior training, or peer coach training?
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Yes
No
Do you have a HCA certificate or exemption letter?
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Yes
No
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Education and Employment Histories
Education History
Rows
Name of School
Type of School
Location of School (City/State)
Dates Attended
Did you graduate? (Yes/No)
Type of Degree/Certificate
School 1
School 2
School 3
School 4
School 5
School 6
School 7
Employment History
Please list your 3 most recent employers, starting with your current/most recent.
Employer 1
Company Name
Position
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date Job Started
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Month
-
Day
Year
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Date Ended
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Month
-
Day
Year
Date Picker Icon
Duties/Responsiblities
Reason for leaving
Employer 2
Company Name
Position
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date Job Started
-
Month
-
Day
Year
Date Picker Icon
Date Ended
-
Month
-
Day
Year
Date Picker Icon
Duties/Responsiblities
Reason for leaving
Employer 3
Company Name
Position
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date Job Started
-
Month
-
Day
Year
Date Picker Icon
Date Ended
-
Month
-
Day
Year
Date Picker Icon
Duties/Responsiblities
Reason for leaving
References - Please list 2 Personal and 2 Professional
Rows
Name
Phone Number
Address
Number of years known
Explain how you know this person
Have you ever worked with this person?
Best time for us to call?
Personal 1
Yes
No
Personal 2
Yes
No
Professional 1
Yes
No
Professional 2
Yes
No
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The Kaler House, Inc.
Disclosure
“Kaler Residential Services” provides residential supported living services and is a division of The Kaler House, Inc. Therefore, representatives of Kaler Residential Services are, in fact, also representatives of The Kaler House, Inc.
Release
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I understand that any omission or misstatement on this application or on any documents used to secure employment shall be grounds for immediate discharge if I am employed, regardless of the time elapsed before discovery. I hereby authorize The Kaler House, Inc., and it’s authorized representatives, to thoroughly investigate my references, work records, education and other matters related to my suitability for employment and, further authorize my current and former employers to disclose to this company any and all letters, reports and other information pertaining to my employment with them, without my need for further authorization or notice for such disclosure or sharing of information. In addition, I hereby release The Kaler House, Inc. (aka Kaler Residential Services), my current and former employers, and all other persons, educational institutions, law enforcement organizations, corporations, partnerships and associates from any and all claims, demands, or liabilities arising out of or in any way related to such investigations or disclosure. I understand that nothing contained in this application or conveyed to me during any interview which may be granted is intended to create any employment contract, implied or explicit, between me and The Kaler House, Inc. I understand that if employed, my employment relationship with The Kaler House, Inc. is for no definite period of time and may be terminated at any time, with or without prior notice, with or without cause or reason, at the option of The Kaler House, Inc. , or myself. I understand and agree that any future changes in my title, duties, compensation, working conditions, and/or other benefits, policies, and procedures will not alter my at-will employment. I understand that if offered employment, I will, as a condition of my employment, be required to submit proof of my identity and legal right to work in the United States on, or prior to, my first day of employment. If the position applied for requires driving in the course of work, I understand that I will be required to possess a current and valid Washington State driver’s license and understand that I will be required to provide a copy of my driver’s insurance and may be asked to provide a copy of my official driving record. I understand that any offer of employment is contingent on my ability to be covered by vehicle insurance, if required for my position.
My digital signature below certifies that I have read and understand this complete page and agree to the terms and conditions outlined in this document.
Signature
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