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Application

This application will help us determine how you might best fit into our organization. After review, we may follow up with a phone call and have you come in for an interview.

Please enter your application information below. Items shown in red are required.

First Name:
Last Name:
Addr 1:
Addr 2:
City:
State:
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Zip Code:
Daytime Telephone: (Format: 555-222-3434)
Alternate Telephone: (Format: 555-222-3434)
E-mail Address:
Who referred you to ReFocus, Inc?
What kind of work are you looking for?
What shifts are you available to work? (Enter "Not available" where applicable."
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Do you anticipate any schedule changes in the near future?
Do you have a car that is registered, insured, and inspected?
Have you had your Driver's License for three years?
Do you have any violations or suspensions on your driving record?
Do you feel comfortable using your vehicle when needed?
Are you able to provide a clean background check?
Have you obtained a high school diploma or GED?
If so, please list what school or organization:
College:
Trade, Business, or Correspondence School:
Special Training or Skills:
Most Recent Employer:
Start Date:
End Date:
Position:
Reason for Leaving:
Name of Reference (must be supervisor):
Reference Contact Information:
Previous Employer:
Start Date:
End Date:
Position:
Reason for Leaving:
Name of Reference (must be supervisor):
Reference Contact Information:
Previous Employer:
Start Date:
End Date:
Position:
Reason for Leaving:
Name of Reference (must be supervisor):
Reference Contact Information:
Previous Employer:
Start Date:
End Date:
Position:
Reason for Leaving:
Name of Reference (must be supervisor):
Reference Contact Information:
Why are you interested in applying for a position with ReFocus, Inc.?
What types of supports do you think should be provided to an individual with physical and/or developmental needs?
What qualities do you think a Direct Support Professional should possess?
Do you feel comfortable assisting both females and males with personal hygiene?
List three qualities about yourself that make you an ideal candidate:
List an area of personal and/or professional growth that is of interest to you:
What is a goal you would like to achieve in the next year?
Is there additional information you would like for us to know about you?
What is your best availability for us to schedule an interview?


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Explore ReFocus


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