Fill Out the Form & Submit Your Application Job Application Email(Required) Applicant's First, Middle, Last Name(Required) Mailing Address(Required) Phone Number(Required)Must Be 18 Years or Older(Required) Under 18 18+ Have You Been Employed With INCOR Before?(Required) Yes No What Position Are You Applying for?(Required)DSS (Direct Support Staff)Program ManagerOtherAre You Seeking Part Time or Full Time?(Required) Full time Part time Are There Certain Shifts You Are Interested in?(Required) 1st shift (Overnights) 2nd shift (Days) 3rd shift (Nights) What Days Are You Available?(Required) Monday Tuesday Wednesday Thursday Friday Saturday Sunday If Hired, When Can You Start?(Required) MM slash DD slash YYYY Do You Have Relatives Working for INCOR?(Required) Yes No If Yes, List Name(S). Otherwise, Put N/a (Not Applicable)(Required) How Did You Hear About Us?(Required) Word of mouth (friend, family) Website Facebook Rehire Current employee If Referred by an Employee, List Name. Otherwise, Put N/a (Not Applicable)(Required) What Training or Certifications Have You Received? Must Provide Copies Upon Hire(Required) In Order to Work for INCOR, You Must Have the Following: These Are Mandatory Before Hire!Do You Have a Valid Drivers License?(Required) Yes No Clean, Reliable Transportation? Some Positions Will Require You to Transport Individuals Around the Community.(Required) Yes No Current Auto Insurance?(Required) Yes No You May Be Required to Lift Up to 40lbs, as Well as Bending, Twisting, Stooping, and Walking. Can You Perform These Activities Without Assistance?(Required) Yes No Are You Eligible for Work in the US?(Required) Yes No Maybe High School Diploma or GED?(Required) Yes No We Are Required to Check Criminal Records, References, and Abuse and Neglect Registry Before Hiring.If There is Anything on Your Background, Do You Have a Disposition for Said Conviction? a Copy Will Be Required Before You Can Be Put to Work.(Required) Yes No N/A Would You Be Willing to Take a Drug Test as a Condition of Employment?(Required) Yes No Have You Ever Served or Currently Serve in the Military?(Required) Yes No If Yes, Please List Rank, Date of Service, and Any Relevant Skills Required. Otherwise, Put N/A (Not Applicable).(Required) Please List Most Previous Employment, Starting With the Most Recent. MM/DD/YYYY(Required) MM slash DD slash YYYY Place of Employment Please List 3* References With Name and Phone Number(Required) Are You Capable of Using Technology Such as a Tablet or Computer to Clock in/out and Complete Documentation?(Required) Yes No Do You Have Experience Working With People With Disabilities?(Required) Yes No If Yes, Please Explain. Otherwise, Put N/A (Not Applicable).(Required) Have You Worked With an Individual Who Could Get Physically Aggressive (Hits, Bites, Scratches, Etc)?(Required) Yes No How Did You Feel About Working With Someone Who Could Get Physically Aggressive?(Required) How Do You Feel About Working With Someone Who Does Not Communicate in Words?(Required) On a Scale of 1 to 5, One Being Very Comfortable and Five Being Unwilling or Unable to Do It, Rank Yourself on the Following Tasks.Cook Healthy Meals(Required) 1 2 3 4 5 House Cleaning(Required) 1 2 3 4 5 Bathing Clients(Required) 1 2 3 4 5 Toileting(Required) 1 2 3 4 5 Changing Briefs(Required) 1 2 3 4 5 Providing Other Total Care Activities (May Include Tube Feeding, Colostomy Care, Etc.)(Required) 1 2 3 4 5 If Offered a Position, Would You Be Willing to Provide Identification of Your Sex, and Ethnicity/Racial Group and/or Disability So That We Can Monitor the Effectiveness of Our EEOC Program? Providing the Information Will Not Affect Your Employment Application.(Required) Yes No Prefer not As a Condition of Employment for a Safety-sensitive Position, I May Be Required to Undergo a Drug and Alcohol Abuse Screening Test Prior to Appointment and I Must Meet Background and Medical Standards as Well.(Required) I have read and acknowledge this statement. I Also Understand That This Application, Supplements and Attachments Become the Property of INCOR, Personnel Department. No Copies of These Documents Shall Be Made Available to or Provided to Me Until the Entire Examination is Complete.(Required) I have read and acknowledge this statement. I Certify That All Statements on This Application and Attachments Are True and Complete to the Best of My Knowledge. I Understand That False, Misleading or Incomplete Information Shall Be Sufficient Cause for Disqualification or Dismissal and Other Penalties as May Be Prescribed by Law.(Required) I have read and acknowledge this statement. Applicant Digital Signature(Required)PhoneThis field is for validation purposes and should be left unchanged.
