Apply for Behavioral Direct Support Professional

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:Behavioral Direct Support Professional
ID:1114
Location:Orting, WA
Salary Range:$19-$25
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Employment Application
Date of Birth:

Employment History #1

* Are you currently employed?
Yes
No
Company Name
Job Title
Date From
Date To
Phone Number
May we contact?
Yes
No
Reason for Leaving

Employment History #2

Company Name
Job Title
Date From
Date To
Phone Number
May we contact
Yes
No
Reason for leaving

Education

School Name
* Did you graduate?
Yes
No
* Degree Received?
Yes
No

Emergency Contact

* Name and Relationship to you?
* Phone Number

Skills

Please check the tasks below that you have experience with and or are willing to complete.
Incontinence
Cooking and Meal Prep
Bathing/Dressing
Companionship
Transporting Clients
Hoyer Lift
Gait Belt
Client Transfers
Alzheimer's/Dementia
* Desired hourly wage

Disclaimer, Authorization, and Signature

I certify the above stated and indicated are true in fact and no misrepresentation of myself has been made. I understand that any false information, omissions, or misrepresentation of facts will result in rejection from this application and; or discharge at any time during employment period. I authorize Supportive Living NW to verify any and all information contained within this application, but not limited to, criminal history and motor vehicle driving records. I authorize Supportive Living NW (SLNW) to contact me using the contact information (telephone, email, and address) provided on this employment application. Method of contact may include but is not limited to phone call, video call, conference call, voicemail, text message, email, and; or physical mail.

* Signature
* Date
DSP/BDSP Prescreening Questions

About You

* Are you at least 18 years or older?
Yes
No
* Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment)
Yes
No
* Have you ever worked for this Company before?
Yes
No
* Do you have a valid driver's license, a clean driving record, auto insurance, and a reliable vehicle?
**Driving clients in your personal vehicle is a requirement of this position**
Yes
No
* Are you comfortable driving clients in major city areas?
Yes
No
* Are you able to preform the essential functions of the job for which you are applying , with or with out reasonable accommodation?
Yes
No
If no, please explain

Experience and Preferences

* Do you have the 75 hour training certificate?
Yes
No
* Do you have any of the following Certificates/Licenses?
NAR
NAC
HCA
CPR
Other
If  other please list below
* Do you have any additional certifications or training such as Right Response, Autism, elopement, or high behaviors? If so, please list below
Yes
No
* Are you comfortable working with a client who needs assistances with incontinent care?
Yes
No
* Are you comfortable working with clients who are bed bound/ limited mobility?
Yes
No
* Are you comfortable working with a client who requires a Hoyer Lift?
Yes
No

Availability

* What days are you available to work?
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
* What shifts are you available to work?
6:00 am to 2:00 pm
2:00 pm to 10:00 pm
10:00 pm to 6:00 am
Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender:
Female
Male
I Choose Not to Respond
Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond
Veteran Status: (Please check all that apply)
Vietnam Era Veteran
A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
Disabled Veteran
1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability.
War/Campaign/Expedition Veteran
A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.
Armed Forces Service Medal Veteran
A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty.
Recently Separated Veteran
Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.
I Choose Not to Respond

Submit
Cancel
ApplicantStack powered by Swipeclock