EMPLOYMENT APPLICATION

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
Address:*

Street Address

Street Address Line 2

CityState / Province

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

Area CodePhone Number
Important Note About Work Hours (PLEASE READ)

This role serves youth and young adults, most of whom are school-age. As such, core hours typically occur after 3:30 PM on weekdays, and weekends. If you are not available after 3:30 PM and/or cannot work weekends, this position may not be a suitable fit.
AVAILABILITY & PREFERENCES
Position Applying For:
Date Available to Start*

MonthDayYear
Date
Desired Hourly Rate:*

Please indicate the days and times you are available to work (check all days that apply and enter the specific hours you are available each day).

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

Available to work weekends?*

YesNo
Preferred Weekly Hours:**

10–15 hours per week16–20 hours per week21–25 hours per week26–30 hours per weekFlexible within part-time limits
Preferred Work Schedule:*

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)Comfortable with all age groups
List any days and times you are unavailable to work.
How did you hear about this position?*

Company WebsiteSchool/University ContactCommunity EventOther
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
Check all that apply:

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
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:
Hobbies, interests, or other information:
UPLOAD RESUME: If you have trouble uploading documents, email document(s) to hr@rbcsupportservices.org

Upload a File

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

Important Note About Work Hours (PLEASE READ)

AVAILABILITY & PREFERENCES

TRANSPORTATION & ELIGIBILITY

EDUCATIONAL HISTORY:

HIGH SCHOOL or GED:

COLLEGE:

SKILLS & EXPERIENCE

EMPLOYMENT HISTORY:

REFERENCES:

UPLOAD RESUME: