Apply for Direct Support Professional (DSP)

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:Direct Support Professional (DSP)
ID:1001
Department:Client Services
Resume
Resume:
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Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
Work Phone:
* Email:
Social Security Number:
Attachments
Cover Letter:
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GMR Employment Application

GMR is an equal opportunity employer and does not discriminate against applicants or employees on the basis of sex, race, color, religion, national origin, age, disability or any other reason prohibited by law.

FAILURE TO COMPLETE THE APPLICATION MAY RESULT IN NOT BEING CONSIDERED FOR A POSIITON

General information
Yes   No
Yes   No
Yes   No
Advertisement   Bureau of Employment Services   Current Employee   Other
Full - Time   Part -Time
Yes   No
Yes   No
Yes   No
Yes   No
Yes   No
Availability

(please list hours of availability with the understanding we serve some individuals 24 hours a day / seven days a week)

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Weekend Companionship Shift

Yes   No
Employment History Begin with most recent employer and account for your last five employers. Please account for all gaps in employment not covered by education and military service.

Employer 1

Employer 2

Employer 3

Employer 4

Employer 5
Education History

High School

9   10   11   12

College

9   10   11   12

Other

9   10   11   12
Personal References

First Reference

Second Reference

Third Reference

Additional Qualifications

This position may require lifting, bending, stooping and walking.

Misleading or intentional false information in this application or during the interview process of this agency may result in withdrawal of job offer or immediate termination if discover after employment has began.

Certification and Authorization

Please read thoroughly before signing

I certify that all facts contained in this application are true and accurate to the best of my knowledge. I furthermore give my consent to GMR permitting them to verify the accuracy of the information contained herein and I authorize former employers and educational institutions to release any information to GMR requested concerning me. I understand that any falsification, misrepresentation or omission of requested facts may result in denial of employment or if employed, may result in immediate dismissal. I understand and agree that if hired, my employment will not be for a definite time period and may, regardless of the date of payment of wages, be terminated at anytime without previous notice and without reason, at the will of either myself or GMR Exceptional Care, Inc. I understand that the ability to drive and be a licensed driver is a requirement with GMR Exceptional Care, Inc. and therefore I must furnish GMR a copy of a valid driver's license and allow GMR access to my criminal and traffic records. I also understand and agree that no one is authorized to promise job security or continued employment. The information obtained by GMR for employment purposes will remain confidential, except for information required by government agencies.

Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender:
Female
Male
I Choose Not to Respond
Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond
Veteran Status: (Please check all that apply)
Individual with a Disability
An individual with a disability is a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, or who has a record of such impairment.
Vietnam Era Veteran
A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
Disabled Veteran
1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability.
War/Campaign/Expedition Veteran
A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.
Armed Forces Service Medal Veteran
A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty.
Recently Separated Veteran
Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.
I Choose Not to Respond

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