Applicant Registration Form
Complete your information, select your role and availability, and confirm your virtual interview details.
Applicant Information
First Name
*
Last Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
City
*
County of Residence
*
Experience
Do you have at least three (3) years of experience working with children or adults with developmental disabilities, autism, behavioral health needs, or intellectual/developmental disabilities?
*
Yes
No
Which county would you MOST like to work in?
*
Please Select
Alamance
Alexander
Alleghany
Anson
Ashe
Avery
Beaufort
Bertie
Bladen
Brunswick
Buncombe
Burke
Cabarrus
Caldwell
Camden
Carteret
Caswell
Catawba
Chatham
Cherokee
Chowan
Clay
Cleveland
Columbus
Craven
Cumberland
Currituck
Dare
Davidson
Davie
Duplin
Durham
Edgecombe
Forsyth
Franklin
Gaston
Gates
Graham
Granville
Greene
Guilford
Halifax
Harnett
Haywood
Henderson
Hertford
Hoke
Hyde
Iredell
Jackson
Johnston
Jones
Lee
Lenoir
Lincoln
Macon
Madison
Martin
McDowell
Mecklenburg
Mitchell
Montgomery
Moore
Nash
New Hanover
Northampton
Onslow
Orange
Pamlico
Pasquotank
Pender
Perquimans
Person
Pitt
Polk
Randolph
Richmond
Robeson
Rockingham
Rowan
Rutherford
Sampson
Scotland
Stanly
Stokes
Surry
Swain
Transylvania
Tyrrell
Union
Vance
Wake
Warren
Washington
Watauga
Wayne
Wilkes
Wilson
Yadkin
Yancey
What city are you applying to work in?
*
Please Select
Bladensboro
Cary
Clayton
Deep Run
Durham
Fayetteville
Four Oaks
Fuquay-Varina
Holly Springs
Kenansville
Kinston
Raleigh
Southern Pines
Washington
Wendell
If work is unavailable in your preferred city, which other county or town would you be willing to work in?
*
How far are you willing to travel?
*
Up to 15 miles
Up to 30 miles
Up to 45 miles
Up to 60 miles
Anywhere within my region
Which days are you available?
*
Monday 4pm -7pm
Tuesday 4pm -7pm
Wednesday 4pm -7pm
Thursday 4pm -7pm
Friday 4pm -7pm
What hours are you available?
*
Evening (5 PM – 10 PM)
Specifically what hours are you
available
?
Hours
Earliest time you can begin work
*
Hour Minutes
AM
PM
AM/PM Option
Latest time you can begin work
*
Hour Minutes
AM
PM
AM/PM Option
Approximately how many hours per week are you seeking?
*
Less than 10
10–20
20–30
30–40
40
Which populations have you worked with?
*
Autism Spectrum Disorder
Intellectual/Developmental Disabilities (I/DD)
Behavioral Health
Mental Health
Children
Adults
Elderly
None
Briefly describe your experience
Do you have a valid driver's license?
*
Yes
No
Do you have reliable transportation?
*
Yes
No
Do you have valid automobile insurance?
*
Yes
No
Do you have CPR/First Aid certification?
*
Yes
No
Have you ever worked for Management Care Services?
Yes
No
Are you bilingual?
*
Yes
No
Acknowledgment
*
Applicant Certification and Acknowledgment By signing below, I certify that the information provided in my application is true and complete to the best of my knowledge. I authorize Management Care Services to conduct any lawful investigations or inquiries concerning my employment, education, qualifications, references, and other matters relevant to an employment decision. I release former employers, educational institutions, references, and other individuals or organizations from liability for providing information related to my application. I understand that false, incomplete, or misleading information provided during the application or interview process may result in disqualification from consideration or termination of employment if discovered after I am hired. I further understand that, after my application is received, a recruiter may contact me to discuss available positions and determine whether my qualifications, experience, availability, and location are a suitable match. Submitting this application does not guarantee an interview, job offer, work assignment, or position with Management Care Services.
Applicant name
*
First Name
Middle Name
Last Name
Apply
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