REFLEKTIONS_LTD_APPLICATION

REFLEKTIONS LTD.

Employment Application - Direct Support Professional
SECTION 1

POSITION INFORMATION
Employment Type Sought:
This position requires nights, weekends, and holidays. Are you available to work a schedule that includes these requirements?
Please describe your availability in detail. (There are no first shift openings)
SECTION 2

APPLICANT INFORMATION
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Best Way to Contact You
Section 3

Education and Certification
Do you possess a high school diploma/ged or equivalent?
Current certifications (Check all that apply)
Are there any other skills or certifications that you would like us to consider?
Section 4

Employment History
Current Employer
Title
Dates Employed
Describe the responsibilities of your role:
Previous Employer
Title
Dates Employed
Describe the responsibilities of your role:
SECTION 5

OHIO BACKGROUND CHECK DISCLOSURE & CONSENT
Have you ever been convicted of, or pleaded guilty or no contest to, any criminal offense that has NOT been sealed by a court of law? A conviction does not automatically disqualify an applicant. Reflektions Ltd. will evaluate the nature of the offense and time elapsed per DODD requirements.
If Yes, please describe (offense, date, jurisdiction, disposition)
Are you listed on any Ohio or federal abuser registry or excluded from participation in federally funded programs?
I understand that a BCI and/or FBI background check will be conducted and that I will be asked to sign a separate authorization prior to the check being conducted.
Section 6

OPEN-ENDED QUESTIONS
Why do you want to work as a Direct Support Professional, and what draws you specifically to supporting individuals with intellectual and developmental disabilities?
Describe a time when you had to adapt your communication style to connect with someone who communicates differently than you do. What did you do, and what was the outcome?
What does person-centered care mean to you? Give a specific example of how you have applied - or would apply this approach in a support role.
Tell us about a time you supported someone through a moment of frustration, distress, or challenging behavior. How did you respond, and what would you do differently, if anything?
Describe a situation where you disagreed with a supervisor or team member about how to support an individual in your care. How did you handle it?
How do you balance supporting someone's independence and personal choices with ensuring their health and safety, especially when those two things feel like they are in conflict?
Describe a time you noticed a change in someone's behavior or health that turned out to be significant. What did you observe, how did you document, and what action did you take?
What does professional boundaries mean to you in this field, and can you describe a real or hypothetical situation where maintaining those boundaries would be challenging?
This work can be physically, but more often, emotionally demanding. What strategies do you use to prevent burnout and maintain consistency in the quality of care you provide?
Is there anything else you would like us to know about your background, skills, or approach to supporting others that is not captured elsewhere on this application?
SECTION 7

PROFESSIONAL REFERENCES
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Section 8

APPLICANT CERTIFICATION & SIGNATURE
I certify:
that all information provided on this application is true, complete, and accurate to the best of my knowledge. I understand that any misrepresentation, falsification, or material omission may disqualify me from consideration for employment, or, if discovered after hire, may result in termination of employment. 
I authorize Reflektions Ltd. to verify the information provided on this application, including contacting references, former employers, and educational institutions. I understand that employment is contingent upon satisfactory background check results as required by Ohio Revised Code § 5123.081, a valid Ohio driver's license check (if applicable), and verification of legal authorization to work in the United States.
I understand that this application does not constitute an offer or guarantee of employment, and that if hired, my employment will be at-will and may be terminated by either party at any time, with or without cause or notice, consistent with applicable Ohio law.

Signature
Should be Empty:

REFLEKTIONS LTD.

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