• Equal Opportunity Employer RisingAssist LLC is an equal opportunity employer and does not discriminate based on race, color, religion, sex, national origin, age, disability, or any other protected status.

  • Format: (000) 000-0000.
  • Eligibility to Work in United States*
  • Valid Driver License*
  • Earliest Start Date*
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  • Days of the Week Available*
  • Able to Work Short Notice or Extra Shifts*
  • Experience and Skills
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  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Permission to Contact References
  • Have you ever been convicted of a barrier crime (per VA law)?*
  • I declare that the information I have provided is true and correct, and I consent to reference checks, background checks, and the use of my personal information for recruitment purposes.
  • Are you willing to complete the following (CHECK ALL)*

  • I understand that employment in this position requires compliance with all Virginia DBHDS regulations, including background checks, training, and adherence to person-centered care standards.

     

  • I certify that all information provided is true and complete.*
  • Date of agreement*
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