Application

1
Applicant Name* This field is required.
First Name
Middle Name
Last Name
Maiden
2
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
3
Email* This field is required.
example@example.com
4
Phone Number* This field is required.
Area Code
Phone Number
5
Position for which you are Applying:* This field is required.
Direct Support Professional
Support Coordinator
6
Counties interested in working:* This field is required.You may select more than one
Crawford County
Delaware County
Frankin County
Marion County
7
Employment status options you would consider* This field is required.You may select more than one
Full Time
Part Time
Temporary
8
Availability * This field is required.(you can choose more than one)
Morning
Afternoon
Evening
Overnights
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Morning
Afternoon
Evening
Overnights
Morning
Afternoon
Evening
Overnights
Morning
Afternoon
Evening
Overnights
Morning
Afternoon
Evening
Overnights
Morning
Afternoon
Evening
Overnights
Morning
Afternoon
Evening
Overnights
Morning
Afternoon
Evening
Overnights
1 of 7
9
Additional Availability Comments:
10
Do you know anyone who currently works for this Organization?* This field is required.
YESNO
11
If Yes, please provide Employee's name:* This field is required.
Name of Employee
12
Can you , after employment, submit a Birth Certificate or other proof of citizenship?* This field is required.
YESNO
13
If not a U.S. citizen, can you after employment, submit verification of your legal right to work permanently in the U.S.?* This field is required.
YESNO
14
Were you previously Employed by this Organization?* This field is required.
YESNO
15
If you have been previously employed please provide from and to dates.* This field is required.
16
Have you ever been convicted of or pled no contest to a felony?* This field is required.
YESNO
17
If yes, please explain:* This field is required.
18
Have you ever been convicted of a misdemeanor? For purposes of this question, "conviction" includes a plea of no contest, a finding by a judge or jury and bond forfeiture (Conviction will not necessarily disqualify an Applicant).* This field is required.
YESNO
19
If yes, please explain:* This field is required.
20
Do you have a Valid Drivers License?* This field is required.
YESNO
21
Do you have liability insurance on your vehicle?* This field is required.
YESNO
22
If you do not have liability insurance, would you be able to obtain prior to employment?* This field is required.
YESNO
23
Have you been in an accident in the past three years?* This field is required.
YESNO
24
If yes to the above question please list Dates and Nature(head-on, rear end, etc.) of the Accident.* This field is required.
25
Have you received a traffic Citation/Conviction in the past three years?* This field is required.
YESNO
26
If yes to the above question please list Dates and Locations(City and State).* This field is required.
27
Do you have a High School Diploma or GED?* This field is required.
YESNO
28
Do you have any experience working in Developmental Disabilities field?* This field is required.
YESNO
29
If so, please provide a brief description of your experience in the Development Disabilities field:* This field is required.Ex. years of experience, specific training's, certifications acquired, etc.
Huge
Large
Normal
Small
Ok
Ok
30
Do you have CPR/First Aid/AED Certification?* This field is required.
YESNO
31
Do you have Medication Administration Certification?* This field is required.
YESNO
32
How did you hear about Bridges to Independence?* This field is required.
33
What is it you'd like to be doing 2-3 years from now?* This field is required.
34
What do you feel is an acceptable number of days to be absent from work in a year?* This field is required.
35
What do you feel is an acceptable number of times to be tardy in a 1 month period?* This field is required.
36
If we were to hire you , would you have any problems getting to and from work or transporting Individuals in your vehicle?* This field is required.
YESNO
37
If yes, please explain:* This field is required.
38
In any of your experience have you had to deal with any behavior problems?* This field is required.
YESNO
39
If yes, please explain* This field is required.
40
How would you feel personally if a person became aggressive towards you?* This field is required.
41
What do you expect from your direct supervisor and/ or the company?* This field is required.
42
Describe for me who you are?* This field is required.
43
Do you have any hobbies or things you enjoy doing?* This field is required.
44
List any comments or qualifying statements you care to make:
45
I understand that Bridges to Independence is continually looking for qualified applicants. I also understand my application may not be currently be a match for the placement the company has available due to the hours I can work or the Employment status for which I am seeking, among other things. I understand my application will be kept active for a period of 45 days from the date this application is submitted.* This field is required.
AgreeDo Not Agree
46
I understand that due to State and Local regulations, Bridges to Independence is required to initiate a criminal background check and motor vehicle record check prior to employment to ensure eligibility in accordance with the above rules. I further understand that depending on the results of the aforementioned background checks, I may be ineligible for employment with Bridges to Independence unless I am able to have record expunged or points taken off of my license.* This field is required.
AgreeDo Not Agree
47
I certify to the best of my knowledge and belief, the answers given by me to the foregoing questions and the statements made by me in this application are correct and complete. I understand that any false or incomplete information contained in this application may result in my discharge.* This field is required.
AgreeDo Not Agree
48
Signature* This field is required.
ClearSignature
49
Can you please provide your feedback/opinion on completing this online application?Was it difficult or easy to complete? Any feedback is appreciated, positive or negative! We want to make this as easy as possible and still provide us with the information needed!
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: