DSP Interest & Pre-Screening Form
Thank you for your interest in working with individuals with developmental disabilities. This short form helps us confirm eligibility and schedule interviews. Completion takes 2 to 3 minutes.
CONTACT INFORMATION
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
City/Zip Code
*
ELIGIBILITY
Are you at least 18 years old?
*
Please Select
Yes
No
Do you have reliable transportation?
*
Please Select
Yes
No
Are you able to pass a BCI & FBI background check?
*
Please Select
Yes
No
Are you authorized to work in the U.S.?
*
Please Select
Yes
No
AVAILABILITY
What is your work availability? (Check All That Apply)
*
Mornings
Evenings
Overnight
How many hours per week are you seeking?
*
10-20
20-30
30-40
EXPERIENCE & COMFORT LEVEL
Have you worked with individuals with developmental disabilities before?
Please Select
Yes
No
Are you comfortable with any of the following if required? (select all that apply)
*
Personal Care
Behavioral Support
Community Outings
Documentation/Notes
In 1–2 sentences, why are you interested in this Direct Support Professional position?
*
START DATE & CONSENT
When are you available to start?
*
-
Month
-
Day
Year
Date
Submit
Upload Resume
*
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