PKT Enterprises - Pink House - Direct Support Professional (DSP)

First name

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Last name

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Please enter a valid email address.

Phone number (Mobile preferred)

Please enter a valid phone number.

Upload resume (Optional)

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What is your street address?

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Are you at least 19 years old?

Yes No

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What best describes your education and work experience?

You have a bachelor's degree in a field related to human services, and one year of full-time work experience providing direct care services to persons with disabilities

You have an associate degree in a field related to human services, and two years of full-time work experience providing direct care services to persons with disabilities

You have a diploma in a field related to human services from an accredited postsecondary institution and three years of full-time work experience providing direct care services to persons with disabilities

You have a minimum of 50 hours of education and training related to human services and disabilities; and four years of full-time work experience providing direct care services to persons with disabilities

None of the above

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Have you ever been employed here before?

Yes

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Are you legally eligible for employment in the U.S.?

Yes No

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If hired, when would you be able to start?

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What is your desired hourly/ salary range?

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What type of employment are you looking for?

Full-Time

Part-Time

Other

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How did you hear about us?

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What is your Driver's License number?

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Work History:

Please fill out the information for at least one of your previous employers.

What is the name of your previous/ current employer?

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How long were you employed? (please include start and stop dates)

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What was your Job Title?

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Please summarize the nature of the work you performed and what your job responsibilities were.

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What was your Supervisor's Name and Title?

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What was your previous Supervisor's number?

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May we contact them?

Yes

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What was your reason for leaving?

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What is the name of your previous employer?

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How long were you employed? (please include start and stop dates)

This is a mandatory field.

What was your Job Title?

This is a mandatory field.

Please summarize the nature of the work you performed and what your job responsibilities were.

This is a mandatory field.

What was your Supervisor's Name and Title?

This is a mandatory field.

What was your previous Supervisor's number?

This is a mandatory field.

May we contact them?

Yes

This is a mandatory field.

What was your reason for leaving?

This is a mandatory field.

What is the name of your previous employer?

This is a mandatory field.

How long were you employed? (please include start and stop dates)

This is a mandatory field.

What was your Job Title?

This is a mandatory field.

Please summarize the nature of the work you performed and what your job responsibilities were.

This is a mandatory field.

What was your Supervisor's Name and Title?

This is a mandatory field.

What was your previous Supervisor's number?

This is a mandatory field.

May we contact them?

Yes

This is a mandatory field.

What was your reason for leaving?

This is a mandatory field.

Educational Background:

If you have attended multiple different colleges and/or have multiple degrees please make a note in your answer to related questions.

What is the name and location of the High School you attended?

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How many years of High School did you complete?

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Did you graduate High School (or obtain equivalent, GED)?

Yes

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Do you have any College level education?

Yes

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What was the name and location of the College you attended?

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How many years of College did you complete?

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Did you Graduate? If Yes, what type of degree did you receive?

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What was your area of study?

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References:

Please provide 1 personal reference and 2 professional ones.

Reference Name:

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What is your relationship to your reference?

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Reference Phone Number:

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How many years have you known your reference?

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Reference Name:

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What is your relationship to your reference?

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Reference Phone Number:

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How many years have you known your reference?

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Reference Name:

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What is your relationship to your reference

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Reference Phone Number:

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How many years have you known your reference?

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Do you Agree to the above applicant statement?

Yes

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Virtual Signature: please type your Full-Name. (note: an electronic signature is the legal equivalent of a manual signature)

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Certifications:

Are you currently Certified in CPR/ First Aid?

Yes

This is a mandatory field.

Are you currently Certified in Medication Administration?

Yes

This is a mandatory field.

Do you have your Mental Health certification?

Yes

This is a mandatory field.

Please describe any other Certifications you may have

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Final Questions:

Is your Driver's License currently valid?

Yes

This is a mandatory field.

Is your Vehicle's Insurance current and is your name listed on the policy?

Yes

This is a mandatory field.

Are you aware of PKT Enterprises' mission of providing quality, communitybased services to vulnerable populations so that they may work, live, socialize, and maintain self-sufficiency in a community setting?

Yes

This is a mandatory field.

Are you willing to work with individuals who may display challenging behaviors such as physical or verbal aggression, difficulty with receptive and expressive language, learning, mobility, self-direction and self-care, and/or limited capacity for independent living or economic self-sufficiency?

Yes

This is a mandatory field.

Are you able to provide physical assistance to individuals with disabilities?

Yes

This is a mandatory field.

Are you able to work more than 40 hours a week on occasion?

Yes

This is a mandatory field.

Are you able to bend, kneel, lift (up to 40 pounds), stoop, stand and/or sit for long periods of time, work in a community environment, handle wheelchair requirements (if needed), with or without reasonable accommodation?

Yes

This is a mandatory field.

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Apply for Direct Support Professional (DSP) in Pink House