Direct Support Professional (DSP)
Your First Name: (required)
Your Last Name: (required)
Your Email: (required)
Upload Resume: (optional)
You may attach your resume to be included with your application for full review.
Applicant must include at least one employer with verifiable reference.
Name of Employer: (required)
Address of Employer: (required)
Employer Phone: (required)
Immediate Supervisor: (required)
Date Employed: (required)
Date Employment Ended: (required)
Starting Pay: (required)
Ending Pay: (required)
Job Title: (required)
Job Duties: (required)
Reason for leaving: (required)
May we use this employer as a reference? (required)
Name of Employer:
Address of Employer:
Date Employment Ended:
Reason for leaving:
May we use this employer as a reference?
Shalom Community Care, Inc. is an equal opportunity employer. Consideration for employment shall not be based on religion, race, color, creed, sex, age, national origin, disability, or military status.
Employment of applicants for direct support services is contingent upon the approval of the individuals or his/her legal representative.
1. I hereby give consent for Shalom Community Care, Inc. to perform a complete background investigation as required under the laws of the State of Tennessee. I understand this investigation may include, but is not limited to, my driving record, criminal records and references. I understand that negative information may affect by eligibility for employment and shall not be considered discrimination by the company.
2. Any material misrepresentation or deliberate omission of facts in this application may be justification for refusal of or termination from employment.
3. Shalom Community Care, Inc will run a thorough investigation of my entire work history and may verify all data given in my application for employment, related papers, and/or oral interviews. I authorized such investigation and the exchange of information requested by Shalom Community Care Inc. I release from liability any person giving or receiving any such information. I understand that falsification of facts so given, or derogatory information discovered as a result of this investigation may prevent my being hired or, if hired, may subject me to immediate dismissal. I understand that falsification of facts so given, or derogatory information discovered as a result of this investigation may prevent my being hired or, if hired, may subject me to immediate dismissal.
4. I authorize any physician or hospital to release information, which may be necessary to determine my ability to perform the duties of a job for which I am being considered.
5. After a conditional offer of employment has been made with Shalom Community Care Inc. I agree to take a medical examination by a qualified physician at the discretion of my employer.
6. I understand that management makes every effort to schedule employees to accommodate individual preferences and religious beliefs. However, the needs of the individuals supported may require overtime, rotation work schedules and locations, and holidays.
7. This is an application for employment. I understand that no employment contract is offered or implied.
8. If I become employed, such employment is for no definite period of time. Shalom Community Care Inc may change wages, benefits and conditions of employment at any time.
9. If I become employed or receive a job status change after employment, I will serve a 90-day conditional probationary employment period.
10. If hired, I may be asked to sign a non-compete contract under company policy.
11. If employed I understand that I may be required to submit to fingerprinting, which will be submitted to the Tennessee State Bureau of Investigations for a complete criminal record check.
12. I consent to a drug screening as possible term or my employment and understand that I may be subject to random drug screening at any given time during my employment. Failure to comply with a drug screening or a positive drug screening may be cause for denial of employment or termination if employed.
I have read, understand, and agree to the above conditions.
E-Signature of Applicant: (required)
E-Signature Date: (required)
*This application will be kept in an active file for 30 days.