Direct Support Professional (DCW)
Please complete all required fields to apply for the position.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Type of Employment desired?
*
Full-time (40 hours/week)
Part-time (No more than 32 hours/week)
Seasonal
Not sure
Beginning Wages Expected?
*
Date Available for Employment?
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-
Month
-
Day
Year
Date
Can you perform the job duties of which you wish to be employed?
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YES
NO (If NO, Please explain in Comments below)
Do you currently have a Valid Michigan Drivers License?
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YES
NO (If NO, Please explain in Comments below)
Do you currently have Auto Insurance?
*
Please Select
Yes
No
Have you ever been employed and/or applied for employment by 3rd Circle? If YES, give dates employed, and indicate if employed under a different name in comments below:
*
Please Select
Yes
No
Do you have any relatives, or a spouse employed by 3rd Circle? If YES, please provide names in comments below.
*
Please Select
Yes
No
Have you ever received Unemployment Compensation? If YES, List all intervals of unemployment during last 10 years in comments below
*
Please Select
Yes
No
Have you ever been administratively determined by any federal, state, or local government agency to have committed abuse or neglect? If YES, please explain in comments below
*
Please Select
Yes
No
Have you ever been convicted of a felony or are there felony charges pending against you? If YES, please explain in comments below
*
Please Select
Yes
No
Are you on a court-supervised probation or parole? If YES, please explain in comments below
*
Please Select
Yes
No
Have charged ever been substantiated against you for abuse, neglect, exploitation, mishandling client funds or any other rights violations in an investigation by any of these organizations below? Check all that apply
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Department of Commerce/Department of Consumer & Industry Services
Department of Social Services/Family Independence Agency
Any local Community Mental Health Recipient Rights Office
Any other Recipient Rights Office
None
Are you a Certified Nurses Aid or do you have a Nursing License? If so, please indicate your license number in the comments below
Please Select
Yes
No
Have you ever served in the U.S. Armed Services? If so, please list Branch of Service, Dates of Active Duty, Describe your duties and any special job related training you received in the comments below.
Please Select
Yes
No
COMMENTS: (Any further information you would like us to know in consideration of your potential employment with 3rd Circle Inc. Please list any other job related licenses, certifications or credentials you may have.)
Work Experience
Education
Upload Resume (PDF, DOC, or DOCX)
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Upload Background Check Documents (Drivers License & SS# Card)
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Background Documents sent to 3rd Circle are secure and not shared with anyone. These documents are required in order for us to move forward with your application. If you would prefer, you can email your background check documents to office.3rdcircle@gmail.com
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We require current certifications for in person Medications, Recipient Rights, and Adult CPR & First Aid trainings as well as all online DSP required trainings from Oakland Community Health Network. Please check all current certifications you have from the list below.
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OCHN ONLINE ONLY training (Docebo Platform)
In-Person Medications
In-Person or Virtual New Hire Rights & Any Annual Rights Updates
In-Person CPR & First Aid
I do not have any current certifications
Please upload your current CPR/First Aid & Recipient Rights certifications (if applicable)
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MONDAY Availability
*
Flexible - Any Shift
Currently NOT available on Monday's
Morning Shift
Afternoon Shift
Midnight Shift
TUESDAY Availability
*
Flexible - Any Shift
Currently NOT available on Tuesday's
Morning Shift
Afternoon Shift
Midnight Shift
WEDNESDAY Availability
*
Flexible - Any Shift
Currently NOT available on Wednesday's
Morning Shift
Afternoon Shift
Midnight Shift
THURSDAY Availability
*
Flexible - Any Shift
Currently NOT available on Thursday's
Morning Shift
Afternoon Shift
Midnight Shift
FRIDAY Availability
*
Flexible - Any Shift
Currently NOT available on Friday's
Morning Shift
Afternoon Shift
Midnight Shift
SATURDAY Availability
*
Flexible - Any Shift
Currently NOT available on Saturday's
Morning Shift
Afternoon Shift
Midnight Shift
SUNDAY Availability
*
Flexible - Any Shift
Currently NOT available on Sunday's
Morning Shift
Afternoon Shift
Midnight Shift
Signature
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