EMPLOYMENT APPLICATION

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

RBC Support Services is hiring for the positions listed above. In these roles, you will support individuals with intellectual, developmental, and/or behavioral health needs by assisting with daily living skills, promoting independence, and encouraging community participation.
SECTION 1: APPLICANT INFORMATION
Full Legal Name:*

First NameMiddle NameLast Name
Date of Birth:*

MonthDayYear
Date
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail Address:*
Phone Number:*

Area CodePhone Number
Company WebsiteSchool/University ContactCommunity EventOther
SECTION 2: POSITION
Position Applying For:
Date Available to Start*

MonthDayYear
Date
Desired Hourly Rate:*
SECTION 3: AVAILABILITY & PREFERENCES

Please indicate the days and times you are available to work. Check all applicable days and list the specific hours you are available for each day.

Rows	Available (✓)	Available Hours (EXAMPLE: 3PM-8PM)
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY

YesNo
10–15 hours per week16–20 hours per week21–25 hours per week26–30 hours per weekFlexible within part-time limits
Early Childhood (ages 3–6)Children (ages 7–12)Teens (ages 13–17)Young Adults (ages 18–25)Comfortable with all age groups
Day (our day shifts typically start at or after 3pm during the week)EveningWeekendsAnyOther
0-5 miles6-10 miles11-15 miles16-20 miles21-25 miles25+ miles
Dates/Times Unavailable:
SECTION 4: TRANSPORTATION & BACKGROUND
YesNo
YesNo
YesNo
YesNo
If yes, explain:
SECTION 5: EDUCATIONAL HISTORY:
HIGH SCHOOL/GED:
High School Name or GED:*
City, State:*
Year:*
COLLEGE/UNIVERSITY:

(if applicable)
College/University:
Years Attended:
Major:
YesNo
Other Education/ Certifications, etc:
SECTION 6: SKILLS & EXPERIENCE
Assisting individuals with mental illness/developmental disabilitiesCompleting documentation and progress notesCommunity integration and socializationProviding in-home personal careSupporting non-verbal individualsManaging challenging behaviors and de-escalation techniquesTeaching/Modeling independent living skillsImplementing behavior intervention plansCoordinating with case managers and social workers
SECTION 7: EMPLOYMENT HISTORY
EMPLOYER #1:*
Rows Date Started Date Ended

Dates worked for
Employer Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Salary/Hourly pay: *
Supervisor Name & Contact:*
EMPLOYER #2
Rows Date Started Date Ended

Dates worked for
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Salary/Hourly rate:
Supervisor Name & Contact:
SECTION 8: REFERENCES
Reference #1 (Name & Phone Number):*
Reference #2 (Name & Phone Number):*
Reference #3 (Name & Phone Number):
Hobbies, interests, or other information:
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

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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:

Rows	Date Started	Date Ended
Dates worked for

Rows	Date Started	Date Ended
Dates worked for

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

SECTION 1: APPLICANT INFORMATION

SECTION 2: POSITION

SECTION 3: AVAILABILITY & PREFERENCES

SECTION 4: TRANSPORTATION & BACKGROUND

SECTION 5: EDUCATIONAL HISTORY:

HIGH SCHOOL/GED:

COLLEGE/UNIVERSITY:

SECTION 6: SKILLS & EXPERIENCE

SECTION 7: EMPLOYMENT HISTORY

SECTION 8: REFERENCES

UPLOAD RESUME: