Job Application

Please fill out the online application below and we will be in touch as soon as possible. Make certain to complete the application completely and if you do not have information for a required field type in na or a past date.

"*" indicates required fields

Application for Employment

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

Position(s) Applied For SELECT ONE*

Resident Assistant

SHC Assistant

Lead Staff

Director

How Did You Learn About Us?*

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Friend

Relative

Did a current Compass Development Employee refer you?

Yes

If you answer YES, who was the Compass Develpment Employee?

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Social Security #*

Birth Date*

MM slash DD slash YYYY

Best Phone # To Reach You At?*

Best Time To Call You?*

Morning

Afternoon

Evening

Anytime

Email*

Have you ever filed an application with us before?*

Yes

If Yes, give date

Have you ever been employed with us before?*

Yes

If Yes, give date

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?*

Proof of status will be required upon employment.

Yes

Date available to work?*

MM slash DD slash YYYY

Desired employment status:*

Check All That Apply

Full Time

Part Time weekends

Part Time weekday/weekend

Sub Status

Desired Shift (all full-time shifts include 1 weekend day)*

Check All That Apply

1st Shift (Sunday - Thursday)

1st Shift (Tuesday - Saturday)

2nd Shift (Sunday - Thursday)

2nd Shift (Tuesday - Saturday)

3rd Shift (Saturday - Tuesday)

3rd Shift (Tuesday - Saturday)

Are you able to lift with no impairment routinely 30lbs and/or assist clients with transferring, ambulation or to assist if they fall?*

Yes

Do you have a valid drivers license?*

Yes

Have you ever been charged/arrested/convicted of a crime(s)?*

Yes

If yes, detail charge/arrest/conviction of the crime(s).

Work Experience

We are an equal opportunity employer. List all jobs within last 5 years (start with your present or most recent employment.) If more denote on back of application. Failure to list all employers will deny employment.

Current or Last Employer*

Address

Start Date*

MM slash DD slash YYYY

End Date*

MM slash DD slash YYYY

If still currently working for this company please enter todays date in this field

Phone

Job Title

Supervisor

Starting Hourly Rate/Salary*

Ending Hourly Rate/Salary*

Work Performed?

Reason for Leaving*

Explain why you left*

May we contact this employer?*

Yes

Employer*

Address

Start Date*

MM slash DD slash YYYY

End Date*

MM slash DD slash YYYY

Phone

Job Title

Supervisor

Starting Hourly Rate/Salary*

Ending Hourly Rate/Salary*

Work Performed?

Reason for Leaving*

Explain why you left*

May we contact this employer?*

Yes

Employer*

Address

Start Date*

MM slash DD slash YYYY

End Date*

MM slash DD slash YYYY

Phone

Job Title

Supervisor

Starting Hourly Rate/Salary*

Ending Hourly Rate/Salary*

Work Performed?

Reason for Leaving*

Explain why you left*

May we contact this employer?*

Yes

Any Comments: Include explanation of any gaps in employment.*

Describe any specialized training and/or skills, hobbies and interests.*

Please Check All Trainings You Have Received

CNA

LPN

Needs Assessment

First Aid

Dietary Needs

Fire Safety

OSHA

CPR

Medication Administration

Challenging Behaviors for CBRF's

Client Group Specific for CBRF's

List qualities that you possess related to this field. Examples: behavioral management, incontinence etc.*

Education

High School*

Address

Years Completed*

Diploma/GED Received*

College

Address

Course of Study

Years Completed

Diploma/Degree Received

Other Education (specify)

If applicable, Address or Location

Course of Study

Years Completed

Diploma/Degree Received

State any additional information you feel may be helpful to us in considering your application.

Personal/Professional References

Please do not include family members or past supervisors.

Reference Name*

Phone*

Best Time To Call?*

Occupation*

Reference Name*

Phone*

Best Time To Call?*

Occupation*

Reference Name*

Phone*

Best Time To Call?*

Occupation*

Applicant's Statement & Digital Signature

I certify that answers given herein are true and complete.
I authorize investigation of all statements contained in this application for employment as it may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 180 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that FALSE or OMMITTED information given in my application or interview may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Type Your Name As Your Digital Signature*

Date*

MM slash DD slash YYYY

To submit, what is 2000+25=*

Name

This field is for validation purposes and should be left unchanged.

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