EMPLOYMENT APPLICATION

Now Hiring – Starting at $15/hr
POSITIONS: Youth Support Specialist | Care Companion | Direct Support Professional | Direct Care Worker |

RBC Support Services is seeking Youth Support Specialists, Care Companions, Direct Support Professionals, and Direct Care Workers. In this role, you’ll provide support to individuals with intellectual, developmental, and/or behavioral health needs, focusing on daily living, independence, and meaningful community engagement.
Full Legal Name:*

First NameMiddle NameLast Name
Date of Birth:*

MonthDayYear
Date
Phone Number:*

Area CodePhone Number
E-mail:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
AVAILABILITY & PREFERENCES
Desired Pay (hourly):*
Preferred Shift (check all that apply):*

10–15 hours per week16–20 hours per week21–25 hours per week26–30 hours per weekFlexible within part-time limits
Preferred Weekly Hours (part-time)*

DayEveningWeekendsAnyOther
Maximum Travel Distance (commute):*

0-5 miles6-10 miles11-15 miles16-20 miles21-25 miles25+ miles
Age Groups You Are Comfortable Working With (select all that apply):*

Early Childhood (ages 3–6)Children (ages 7–12)Teens (ages 13–17)Young Adults (ages 18–25)Adults (ages 26–59)Comfortable with all age groups
Available to work weekends?*

YesNo
TRANSPORTATION & ELIGIBILITY
Do you have reliable transportation and auto insurance?*

YesNo
Are you a United States Citizen?*

YesNo
If no, are you authorized to work in the U.S.?*

YesNo
Have you ever been convicted of a felony?*

YesNo
If yes, explain:
EDUCATIONAL HISTORY:
HIGH SCHOOL or GED:
High School Name or GED:*
City, State:*
Year:*
COLLEGE:

(if applicable)
College Name:
Years Attended:
Focus of Study:
Graduated:

YesNo
Other Education/ Certifications, etc:
SKILLS & EXPERIENCE

(not required)
Check all that apply:

Assisting individuals with mental illness/developmental disabilitiesCompleting documentation and progress notesCommunity integration and socializationProviding in-home personal careSupporting non-verbal individuals using alternative communication methodsManaging challenging behaviors and de-escalation techniquesTeaching/Modeling independent living skillsImplementing behavior intervention plansCoordinating with case managers and social workers
EMPLOYMENT HISTORY:
Most Recent Employer Name:*
Date Started Date Ended

Dates worked for
Most Recent Employer Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Salary/Hourly pay: *
Supervisors Name and Email or Phone:*
Second Most Recent Employer Name:
Date Started Date Ended

Dates worked for
Second Most Recent Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Salary/Hourly rate:
Supervisors Name and Email or Phone:
REFERENCES:
Reference #1 (Name & Phone Number):*
Reference #2 (Name & Phone Number):*
Reference #3 (Name & Phone Number):
I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any misrepresentation may disqualify me from consideration or result in termination if employed.
Name:Date:
UPLOAD RESUME:
UPLOAD RESUME: If you have trouble uploading documents, email document(s) to hr@rbcsupportservices.org

Upload a File

Cancelof
Hobbies, interests, or other information:
Thank you for taking time to complete this job application. We will be in contact with you shortly. We look forward to you potentially becoming part of the RBC Support Services Family.

Email: hr@rbcsupportservices.org

Phone: (248) 396-7589

Website: www.rbcsupportservices.org
Should be Empty:

Now Hiring – Starting at $15/hr

POSITIONS: Youth Support Specialist | Care Companion | Direct Support Professional | Direct Care Worker |

AVAILABILITY & PREFERENCES

TRANSPORTATION & ELIGIBILITY

EDUCATIONAL HISTORY:

HIGH SCHOOL or GED:

COLLEGE:

SKILLS & EXPERIENCE

EMPLOYMENT HISTORY:

REFERENCES:

UPLOAD RESUME: