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
Referral Source:

Other
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

Available to work weekends?
Preferred Weekly Hours:*
Age Groups You Are Comfortable Working With (select all that apply):
Preferred Work Schedule:

Other
Maximum Travel Distance (commute):
Dates/Times Unavailable:
SECTION 4: TRANSPORTATION & BACKGROUND
Do you have reliable transportation and auto insurance?
Are you a United States Citizen?
If no, are you authorized to work in the U.S.?
Have you ever been convicted of a felony?
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:
Degree Received:
Other Education/ Certifications, etc:
SECTION 6: SKILLS & EXPERIENCE
Check all that apply:
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:
Name:Date:
UPLOAD RESUME:
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
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: