Family Support Worker

The families and clients we work with thrive on consistency, therefore we require that our Family Support Workers/Family Peer Advocates commit to at least 10-15 hours a week of services. Is this something you are able to commit to?*

YesNo
This position's schedule is based on the needs of our children and families. Family Support Workers must have after-school, evening, and weekend availability.
What days are you available?*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
What times are you available?*
The Family Support Workers utilize their own vehicle to transport youth during visits. Do you have reliable transportation?*

YesNo
Do you have experience working with children and families with Mental Health Diagnosis and/or Developmental Delays?*

YesNo
Please Elaborate*
Do you have experience working with children and/or families in their home setting?*

YesNo
Please Elaborate*

EDUCATION EXPERIENCE
Are you a High School Graduate?*

YesNo
What month/year?*
Do you have your GED?*

YesNo
Any College?*

YesNo
Please Explain

DRIVING EXPERIENCE
Have you had your license for at least 3 years?*

YesNo
Do you have a clean and valid driver's license?*

YesNo
I hereby agree and grant permission to CAPTAIN and Marshall and Sterling to secure and review my motor vehicle record. I hereby understand that this review is for insurance underwriting purposes only.*

Yes
Driver License #*
Issuing State*
Date of Birth*
Please Confirm The Following Statement*

I will drive my personal vehicle for CAPTAIN business. I carry $100K/$300K liability coverage on my personal auto insurance policy.

MILITARY EXPERIENCE
Military Experience?*

YesNo
What Branch?*
Rank Attained?*
Honorable Discharge?*

YesNo

ADDITIONAL SKILLS/TRAINING
What languages can you speak?*
(Language 1)
(Language 2)
(Language 3)
(Language 4)

Please select how well you know each language you listed.

	Language 1	Language 2	Language 3	Language 4
Speak
Read
Write

Describe any specialized training, apprenticeship, skills and extra-curricular activities.
Describe any job related training received in the United States Military.
Please describe any specialized skills you possess that you feel may be helpful to us in considering your application.
List professional, trade, business or civic activities and offices held.

EMPLOYMENT EXPERIENCE
Current/Previous Employer Name*
Employed From*

MonthDayYear
Employed To*

MonthDayYear
Employer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Job Title*
Work Performed:*
If previous, what is the reason for leaving?

REFERENCES
Reference #1:*

First NameLast Name
Relationship*
Phone Number*
Reference #2:*

First NameLast Name
Relationship*
Phone Number*
Reference #3:*

First NameLast Name
Relationship*
Phone Number*

SUBMISSION
Applicant's Statement:

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I consent to appropriate background screenings pursuant to agency policy, which may include checking any or all of the following; NYS Central Register of Child Abuse and Maltreatment, NYS Sec Offender Registry, Social Secuirty verification, and NYS felony criminal conviction check.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this period of time should inquire as to whether or not applications are being accepted at that time.

I hereby understand that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this orgranization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
Date*

MonthDayYear
Date
Please click to agree. Your click will be considered your digital signature, indicating acceptance of the statement above.*
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