Sweet River SLS Employment Application

Sweet River SLS Employment Application

Personal Attendants start at $19.00 per hour. No experience is required; we provide paid orientation and training. Please complete every section. Do not enter your Social Security number, date of birth, or past pay. A background check happens only after a conditional offer of employment.
Applicant Information
Full Legal Name

First NameLast Name
Preferred Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Best Way to Reach You
Are you at least 18 years of age?
Can you provide proof of legal authorization to work in the United States if hired?
Have you worked for Sweet River SLS or a related program before?
If yes, when?
Position and Availability
Position Applying For

Other
If other, which position?
Employment Desired
Available Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Desired Hourly Pay
Shifts Available
Days Not Available
How Did You Hear About Us?

Other
Qualifications and Certifications
Experience is not required for the Personal Attendant position.
Do you have a working smartphone available for work use, including team chat and agency apps?
Do you currently have CPR and First Aid certification?
Certification expiration date
Do you have a valid California driver license, if assigned to drive?
Do you have reliable transportation to get to work?
Have you supported people with developmental disabilities as a job or otherwise?
Where and how long
Have you completed DSP training (Year 1 or Year 2) or other caregiving training?
Which training
Have you supported medications in a care setting?
Languages spoken fluently

Other
Other language
Education
Note: A high school diploma or equivalent is preferred but not required.
Highest level completed
School 1 Name
School 1 City and State
School 1 Diploma, Degree, or Certificate
School 2 Name (optional)
School 2 City and State
School 2 Diploma, Degree, or Certificate
School 3 Name (optional)
School 3 City and State
School 3 Diploma, Degree, or Certificate
Additional certifications or training
Employment History
List your most recent job first. Include volunteer or caregiving work if applicable. Do not list past pay rates.
Employer 1 Name
Employer 1 Job Title
Employer 1 City and State
Employer 1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer 1 Supervisor Name

First NameMiddle NameLast Name
Employer 1 Dates Employed From

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 1 Dates Employed To

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 1 Main Duties
Employer 1 Reason for Leaving
May we contact Employer 1?
Employer 2 Name (optional)
Employer 2 Job Title
Employer 2 City and State
Employer 2 Phone
Employer 2 Supervisor Name

First NameLast Name
Employer 2 Dates Employed (from and to)
Employer 2 Main Duties
Employer 2 Reason for Leaving
May we contact Employer 2?
Employer 3 Name (optional)
Employer 3 Job Title
Employer 3 City and State
Employer 3 Phone
Employer 3 Supervisor Name

First NameLast Name
Employer 3 Dates Employed (from and to)
Employer 3 Main Duties
Employer 3 Reason for Leaving
May we contact Employer 3?
Employer 4 Name (optional)
Employer 4 Job Title
Employer 4 City and State
Employer 4 Phone
Employer 4 Supervisor Name

First NameLast Name
Employer 4 Dates Employed (from and to)
Employer 4 Main Duties
Employer 4 Reason for Leaving
May we contact Employer 4?
Resume

Cancelof
Professional References
Please provide three professional references who know your work. Do not list family members.
Reference 1 Name

First NameMiddle NameLast Name
Reference 1 Relationship to Applicant
Reference 1 Company
Reference 1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference 1 Email
example@example.com
Reference 2 Name

First NameMiddle NameLast Name
Reference 2 Relationship to Applicant
Reference 2 Company
Reference 2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2 Email
example@example.com
Reference 3 Name

First NameMiddle NameLast Name
Reference 3 Relationship to Applicant
Reference 3 Company
Reference 3 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference 3 Email
example@example.com
Background Clearance and Health Screening
Sweet River SLS does not ask about conviction history on this application. Consistent with the California Fair Chance Act, background checks are conducted only after a conditional offer of employment is made. Because Personal Attendants support adults served by the Regional Center of the East Bay, every new hire must complete Department of Justice and FBI fingerprint clearance (Live Scan), TB clearance, and Form I-9 employment eligibility verification before the first shift.
If offered a position, are you willing to complete Live Scan fingerprinting and TB clearance before your first shift?
Equal Opportunity and Voluntary Information
Sweet River 18ST, Inc. is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, creed, national origin, ancestry, sex, gender, gender identity or expression, sexual orientation, age (40 and over), physical or mental disability, medical condition, genetic information, marital status, military or veteran status, reproductive health decision making, or any other status protected by California or federal law. If you need a reasonable accommodation to complete this application or to interview, contact Human Resources at hr@sweetriversls.com.
Are you a veteran? (optional)
Applicant Certification and Signature
I certify that my answers on this application, and on any resume or attachment I provide, are true and complete to the best of my knowledge. I understand that false, misleading, or missing information may result in my application not being considered or, if I am hired, in separation from employment. I authorize Sweet River 18ST, Inc. to contact the employers and references I listed, except any employer I marked No for contact, and to verify my education and certifications. I understand that if I receive a conditional offer, employment depends on DOJ and FBI fingerprint clearance (Live Scan), TB clearance, and Form I-9 verification. I understand that this application is not a contract of employment; if hired, my employment is at will as permitted by California law. I understand that my application is kept confidential.
I have read and agree to the statements above
Applicant signature
Printed name

First NameMiddle NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Sweet River SLS Employment Application

Applicant Information

Position and Availability

Qualifications and Certifications

Education

Employment History

Professional References

Background Clearance and Health Screening

Equal Opportunity and Voluntary Information

Applicant Certification and Signature