Employment Form

APPLICATION FOR DIRECT CARE EMPLOYMENT

644 Grand Ave- Ste 1
Billings, MT 59101
(406) 248-2055

STEP, Inc. is an Equal Opportunity Employer. We will not determine on the bases of race, color, sex, national origin, veteran status, or disability. Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation for the application and/or interview process should notify the STEP, Inc. Personnel Coordinator.
STEP, Inc. is a Drug-Free workplace by the Drug-Free Workplace Act of 1988.

Personal Information

Date

Last Name

First Name

Middle Initial

Street Address

City

State

Zip Code

Phone

Are you 18 or older

If not, Do you have a work permit?

Yes
No

Yes
No

Position Desired

Habilitation Aide -Working with children

Supported Living Integration Specialist - working with adults

Group Home -Working with Individuals in group home setting.

Other

Date Available

Type of employment

What prompted your application to our company?

Have you ever applied here before?		Yes
Have you ever applied here before?		No

Have you ever been convicted of a Felony? (Do not include convictions that have been sealed, expunged, or statutorily eradicated.)		Yes
		No

Can you, after employment, submit verification of your identity and legal right to work in the United States?		Yes
		No

If you are not a US citizen, What is your Visa status?

Do you have a valid Drivers license?	Yes
Do you have a valid Drivers license?	No

Which State

Reason:

What times are you available?

Education and Training
	High School	College/University
Name
Location
Major
Degree
List other job related training, scholastic honors, and vocational and/or professional information

Experience

Present or most
recent employer

Dates of Employment

Company

Address

City, State, Zip

Supervisor's Name

Phone:

May we Contact?

Yes
No

Yes
No

Yes
No

Your job title:

Starting Salary:

Ending Salary:

Reason for Leaving

References

Reference 1

Reference 2

Reference 3

Name

Address

City, State, Zip:

Phone:

Relationship

I authorize employers and references listed to disclose any and all relevant information concerning prior employment and pertinent character information information to STEP, Inc.

I hereby release all parties and persons connected with furnishing such information from all claims, liability and damages for whatever reason, arising out of furnishing such information.

Do you agree to the above statement?

Date

Yes
No

Preference Information

Are you willing to provide personal care to individuals such as:

helping individuals who are unable to toilet themselves

Yes
No

changing ATTENDS and cleaning after toileting accidents

Yes
No

helping individuals who are unable to feed themselves

Yes
No

Are you willing to assist individuals that have behavioral challenges if:

there is a possibility that an individual may hit or kick you

Yes
No

if there is the possibility that someone may bite you

Yes
No

If someone exhibits inappropriate sexual behavior

Yes
No

if someone yells or uses profanity

Yes
No

Are you willing to assist individuals that have physical challenges by:

lifting and/or assisting individuals that are non-ambulatory

Yes
No

learn to use mechanical devices to assist individuals

Yes
No

Are you willing to help individuals be a part of their community and to:

be dependable and show up for work on time as scheduled

Yes
No

find a qualified replacement for your shift when unable to show

Yes
No

work occasionally for others when they are unable to work

Yes
No

work some holidays

Yes
No

participate in required training within the specified timelines

Yes
No

Terms and conditions of employment

I understand and agree that:

Any material misrepresentation or deliberate omission of a fact in my application may be justification for refusal of, or if employed, termination from employment .

It is my understanding that STEP will make a complete investigation of my work history and may verify all data given in my application for employment, related papers, or oral interviews. I authorize such investigation and the giving and receiving of any information requested by STEP and release from liability any person giving or receiving such information. I understand that falsification of data or other derogatory information discovered as a result of this investigation may prevent my being hire, or if hired, may subject me to immediate dismissal.

I understand that STEP will conduct a Criminal Background Check. I agree to provide STEP, Inc. information regarding any conviction of felony or misdemeanor and the nature of the conviction. I understand that a conviction will not necessarily bar me from employment with STEP, Inc. I further understand that if I do not provide the information before being hired , STEP, Inc. may terminate my employment when the information is obtained.

I agree that my employment may be terminated by this company at any time without liability for wages or salary except such as may be earned at the date of such termination.
Although management makes every effort to accommodate individual preferences, business needs may at times make the following conditions mandatory: overtime, shift work, a rotating work schedule, or a work schedule other then Monday through Friday.

I further understand that this is an application and that no employment contract is being offered. I understand that if I am employed, such employment is for no definite period of time and that STEP can change wages, benefits, and conditions at any time.

Do you agree to the terms and conditions of employment?

Yes
No

Date