Online Employment Application

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Resource, Support, & Development, Inc.

RSD, Inc.
2110 Overland Avenue Suite 126
PO Box 80185
Billings, MT 59108-0185
Ph (406)652-5443 / Fax (406)652-9361

Direct Care Staff Application for Employment

Personal Information:

Are you 18 years of age or older?The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 year of age.

Employment Desired:

Are you currently employed?
If yes, can we contact your present employer?
Are you related to anyone currently employed at RSD, Inc?

General Information:

Have you been convicted of a felony or misdemeanor within the last five (5) years?You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied
Do you have a current Montana Driver's License?
Have you had any traffic infractions in the last three (3) years?
Is there anything on your driving record which would inhibit your ability to transport consumers?This job may require you to transport consumers to and from work, social functions, etc., either in your own vehicle or corporate vehicles.
Please be prepared to provide a copy of your Driver’s License and verification of auto insurance.

Former Employers:

List former employers within the past 10 years, starting with most current first. Do not write “see resume”.

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Please feel free to attach a resume or use additional sheet to explain responsibilities and reasons for leaving.

Summary of Education:

Education Level

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Professional References:

Please provide the names, addresses, and phone numbers for two work references who can attest to your skills and knowledge as they relate to this position, as well as your work habits.

Personal Reference:

Please provide the name, address, and phone number for a personal reference.

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Skills/Experience:

For each of the skills/experiences listed below, check which of these has been a significant part of your past employment or training.

A. Supervisory Experiencepick all that apply
B. Consumer Carepick all that apply
C. Consumer Trainingpick all that apply
D. Facility/Equipment/Vehicle Maintenancepick all that apply
E. Otherpick all that apply

Supporting Documents:

Use this file upload option to add your resume, references, copy of your driver's license, auto insurance, or other documents to this application.

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

IMPORTANT--PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION

RESOURCE, SUPPORT & DEVELOPMENT, INC. (“the Company”) may obtain information about you for employment/volunteer or contractor purposes from a third party consumer reporting agency. Thus, you may be the subject of a “consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living. These reports may contain information regarding your criminal history, military history, social security verification, motor vehicle records (“driving records”), personal and professional reference checks, licensing and certification checks, etc. The information contained in the report will be obtained from private and/or public record sources, including sources identified by you or through interviews or correspondence with your past or present coworkers, neighbors, friends, associates, current or former employers, or other acquaintances.


The nature and scope of any investigative consumer reports that may be requested is explained above. You are nonetheless entitled to request more information about the nature and scope of such reports by submitting a written request to us.


The company will furnish you with a Summary of Your Rights under the Fair Credit Reporting Act in a form prescribed bythe Federal Trade Commission along with required state law notices in states where applicable

Gender
ACKNOWLEDGMENT AND AUTHORIZATION


I acknowledge receipt of the above DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of "consumer reports" by the Company at any time after receipt of this authorization and throughout my assignment or employment, if applicable. I further understand that the Company may obtain “consumer reports” periodically during the duration of my employment with the Company for the purpose of making decisions related to my employment with the Company, and I authorize the Company to obtain “consumer reports” for this purpose. To this end, I hereby authorize, without reservation, any law enforcement agency, branch of the military, administrator, state or federal agency, institution, information service bureau, employer, or reference given to you by me to furnish any and all background information requested by the Company. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as the original.


By submitting this application, I certify that the facts in this application are true and complete to the best of my knowledge. I understand that any false or misleading statements or omissions on this application shall be a bar from being hired or, if discovered after hiring may lead to termination. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information. I release all parties from all liability for any damage that may result from furnishing same to you.

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