Sunny Haven Residential Services - Application for Employment-Sunny Haven RS

First Name

Middle Name

Last Name

Phone Number

Alternate Phone Number

Address (Street Name, Apt/P.O. Box #, City, State, Zip Code)

Mailing Address (if different from above)

Email Address

Date of Birth (MM/DD/YYYY)

Social Security Number (XXX-XX-XXXX)

Highest Level of Education

Employer 1 - Job Title

Employer 1 - Company Name

Employer 1 - Dates of Employment

Employer 1 - Phone Number

Employer 1 - Address

Employer 1 - Pay Rate (Upon Hire and Upon Leaving; if different, please list both)

Employer 1 - Duties Performed

Employer 1 - Supervisor's Name, Title, and Phone Number

Employer 1 Reason for Leaving

Employer 2 Job Title

Employer 2 - Company Name

Employer 2 - Dates of Employment

Employer 2 - Phone Number

Employer 2 - Address

Employer 2 - Pay Rate (Upon Hire and Upon Leaving; if different, please list both)

Employer 2 - Duties Performed

Employer 2 - Supervisor's Name, Title, and Phone Number

Employer 2 - Reason for Leaving

Employer 3 - Job Title

Employer 3 - Company Name

Employer 3 - Dates of Employment

Employer 3 - Phone Number

Employer 3 - Address

Employer 3 - Pay Rate (Upon Hire and Upon Leaving; if different, please list both)

Employer 3 - Duties Performed

Employer 3 Supervisor's Name, Title, and Phone Number

Employer 3 - Reason for Leaving

Upload Your Resumé (optional)

What are your prior experiences that would be applicable to a direct support professional position?

If you selected any of the above choices, please explain your experience in more detail for each:

Reference 1 - (Name, Title, Company, and Phone #)

Reference 2 - (Name, Title, Company, and Phone #)

Reference 3 - (Name, Title, Company, and Phone #)

Position Applicant is Seeking (Choose 1 or more)

Community Engagement (CE) Staff

Direct Support Professional (DSP)

Other Advertised Position

If you checked "Other" to the previous question, please enter the position you are applying for below.

Availability (Choose 1 or more)

Open Availability (Any Day, ALL Hours)

Weekdays

Weekends

Night Shift

Specific Days Available to Work (Choose 1 or more)

For Each Day Selected Above, Enter the Hours You're Available to Work. For example, if you chose Monday and Thursday above you'd need to write "Monday - 8AM to 6PM, Thursday - 9AM to 3PM."

*Shifts and assigned hours are based upon the needs of the company. Shifts vary depending upon employee position & assigned location.

Please note: Selecting a shift(s) above is not to be construed as a promise or guarantee of actual hours employee will work.

Employment Desired (Choose 1 or more)

Full-Time

Part-Time

Any

Have you ever worked for Sunny Haven RS in the past? If yes, please state the dates you worked, position, and the location.

Date Available to Begin

I certify that all information I've provided on this application is true and complete to the best of my knowledge.

In the event of employment, I understand that false or misleading information given in my application and/or interview(s) may result in immediate discharge from Sunny Haven Residential Services.

In the event of employment, I understand that I may be subject to drug screening(s) and both state and federal background checks; I provide my consent for Sunny Haven RS to conduct these as necessary.

Your Signature

*

Date

Diploma (High School and/or College Degree)

Sunny Haven Residential Services - Application for Employment

The Basics

Education History

Employment History

Experience

Personal & Professional References

Position at Sunny Haven Residential Services

Acknowledgement and Authorization