DSP & Caregiver Jobs in Northern Virginia

Position Information

Position(s) applied for

Applying - DSPDSP (Direct Support Professional)Applying - PCAPCAApplying - CNACNAApplying - Medication AideMedication AideApplying - LPNLPNApplying - RNRNApplying - Behavioral SupportBehavioral SupportApplying - House ManagerHouse ManagerApplying - Office AdminOffice Admin

Employment desired

Employment Type - Full-timeFull-timeEmployment Type - Part-timePart-timeEmployment Type - PRNPRN / As Needed

Preferred shift(s)

Shift - DaysDayShift - EveningsEveningShift - OvernightsOvernightShift - WeekendsWeekendShift - HolidaysFlexible

Date available

Desired pay ($)

Referred by

Applicant Information

First name

Middle name

Last name

Preferred name

Date of birth

Street address

Apartment / Unit

City

State

ZIP code

Primary phone

Alternate phone

Emergency Contact

Name

Relationship

Phone

Have you previously applied to or worked for All In All Residential Services?

YesNo

If yes, provide the position and approximate date(s)

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Work Authorization & Employment Requirements

Are you legally authorized to work in the United States?

YesNo

Will you now or in the future require employment sponsorship?

YesNo

Are you at least 18 years of age?

YesNo

Can you perform the essential functions of the position, with or without reasonable accommodation?

YesNo

Are you able to lift at least 50 pounds?

YesNo

Are you willing to work weekends, holidays, and variable schedules when required?

YesNo

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Driver & Transportation

Do you have a valid driver's license?

YesNo

License state

License number

Expiration date

Do you have reliable transportation?

YesNo

Willing to drive company vehicles?

YesNo

Willing to transport individuals?

YesNo

Current auto insurance?

YesNoN/A

List any license restrictions, suspensions, or moving violations within the past three years (or write None)

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Education and Training

High School / GED (School / Institution)

City & State

Diploma / Degree / Certification

Date Completed

College / University (School / Institution)

City & State

Diploma / Degree / Certification

Date Completed

Vocational / Technical (School / Institution)

City & State

Diploma / Degree / Certification

Date Completed

Other Training (Program / Institution)

City & State

Diploma / Degree / Certification

Date Completed

Licenses & Certifications

Check all that apply

Cert - RNRNCert - LPNLPNCert - CNACNACert - Medication AideMedication AideCert - CPRCPRCert - First AidFirst AidCert - DSPDSP CertificationCert - TOVATOVA / Crisis PreventionCert - OtherOther

If other, specify

License / certification number

State / issuing body

Expiration date

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Employment History

List your three most recent employers, beginning with the most recent. Explain any employment gaps longer than three months.

Employer 1

Employer name

Phone

Address

Supervisor

Job title

Dates employed (From - To)

Starting pay

Ending pay

Primary duties

May we contact?

YesNo

Eligible for rehire?

YesNoUnknown

Reason for leaving

Employer 2

Employer name

Phone

Address

Supervisor

Job title

Dates employed (From - To)

Starting pay

Ending pay

Primary duties

May we contact?

YesNo

Eligible for rehire?

YesNoUnknown

Reason for leaving

Employer 3

Employer name

Phone

Address

Supervisor

Job title

Dates employed (From - To)

Starting pay

Ending pay

Primary duties

May we contact?

YesNo

Eligible for rehire?

YesNoUnknown

Reason for leaving

Employment gaps longer than three months (dates and explanation)

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Professional References (not relatives; at least one former supervisor)

Reference 1 - Name

Relationship

Phone / Email

Years known

Reference 2 - Name

Relationship

Phone / Email

Years known

Reference 3 - Name

Relationship

Phone / Email

Years known

Relevant Experience & Competencies

Check all areas in which you have direct work experience:

Comp - IntellectualIntellectual DisabilitiesComp - DevelopmentalDevelopmental DisabilitiesComp - AutismAutism Spectrum DisordersComp - Mental HealthMental Health SupportComp - BehavioralBehavioral SupportComp - MedicalMedical / Complex CareComp - MedicationMedication AdministrationComp - WheelchairWheelchair / Mobility SupportComp - HoyerHoyer Lift / TransfersComp - CoachingCommunity CoachingComp - EngagementCommunity EngagementComp - Personal CarePersonal Care / ADLsComp - DocumentationDocumentation / ISP DataComp - CrisisCrisis Prevention / De-escalationComp - TransportationTransportation of Individuals

Total years of direct care experience

Total years of supervisory experience

Electronic documentation systems used

Languages spoken

Briefly describe your experience supporting individuals with developmental disabilities, behavioral needs, or medically complex conditions

Why are you interested in working with All In All Residential Services?

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Availability

Days available (check all that apply)

Avail MonMondayAvail TueTuesdayAvail WedWednesdayAvail ThuThursdayAvail FriFridayAvail SatSaturdayAvail SunSunday

Shift times available (check all that apply)

Avail MorningMorningAvail AfternoonAfternoonAvail EveningEveningAvail OvernightOvernight

Earliest start time

Latest end time

Max hours / week

Any recurring scheduling restrictions?

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Background & Pre-Employment Screening

A Yes response does not automatically disqualify an applicant.

Willing to complete a criminal background check?

YesNo

Willing to complete a Child Protective Services (CPS) registry check?

YesNo

Willing to complete other abuse/neglect registry checks when required?

YesNo

Willing to complete a DMV record review if the position requires driving?

YesNo

Willing to complete a TB screening and health assessment if required?

YesNo

Willing to complete drug screening if required by company policy or the position?

YesNo

Have you ever been excluded, suspended, or debarred from a federal or state healthcare program?

YesNo

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Disclosure & Certification

Have you ever been convicted of, pled guilty to, or pled no contest to a criminal offense (excluding minor traffic violations)?

YesNo

If yes, please explain (do not disclose sealed or expunged information)

Is your name listed on the Virginia CPS Central Registry, the Adult Protective Services Registry, or any state sex offender registry?

YesNo

Has your professional license or certification ever been suspended, revoked, or subject to disciplinary action?

YesNoN/A

Applicant Certification

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation may disqualify me from employment consideration or result in termination if discovered after hire. I understand that this position involves direct contact with individuals receiving services under a DBHDS-licensed program and that employment is contingent upon successful completion of a criminal background check, Central Registry searches, sex offender registry search, and any other screening required under Virginia law and agency policy prior to unsupervised contact with individuals served. I understand that this application does not constitute an offer of employment or a contract.

Consent CertifiedI certify and agree to the statement above.

Signature (type your full name)

Date

Printed name

Preferred contact method

PhoneEmail

How did you hear about us?

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Position Information

Applicant Information

Emergency Contact

Work Authorization & Employment Requirements

Driver & Transportation

Education & Licenses

Education and Training

Licenses & Certifications

Employment History

Employer 1

Employer 2

Employer 3

References & Experience

Professional References (not relatives; at least one former supervisor)

Relevant Experience & Competencies

Availability

Background & Pre-Employment Screening

Disclosure & Certification

Applicant Certification

Equal Opportunity Employer