Job Application: Personal Support Attendant (Direct Support Professional) 2017-10-06T21:27:26+00:00

Title: Personal Support Attendant (Direct Support Professional)

Fields marked with an asterisk (*) must be filled out before submitting.

Thank you for applying for employment with TNC Community. Before completing the application, please review the following list of basic requirements. In order to be considered for employment, all applicants must meet the following basic criteria.

Basic requirements for employment. Select which option applies: * High School Diploma
Click here for acceptable documentation
Name *

Personal Information

Previously used names (alias, maiden names, nicknames, etc.)
Referred By:
Email Address *
Cell Phone *
Alternate Phone
Address *
City *
State or Province
Zip *
Is this your permanent address Yes
If no, what is your permanent address?

TNC Group Homes operate on standardized scheduling for our direct care positions. Our Individual Supported Living (ISL) locations operate on different schedules. Please select the following days, time and locations in which you are interested.

Work Days: First Choice
Work Days: Second Choice
Times: First Choice
Times: Second Choice
Locations: First Choice
Locations: Second Choice
Locations: Third Choice

Employment Desired

Position Desired
Salary Desired
First Available Date
Have you ever worked for TNC Community before? Yes
If yes, when? Please state your reason(s) for leaving

Background Information

Are you legally authorized to work in the U.S.? Yes
Have you ever been convicted of a crime? Yes
If YES, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation (A conviction will not necessarily result in the denial of employment
How many motor vehicle accidents have you been involved in during the past three years?
How many moving violations have you received in the past three years?


High School: Name, Location
High School: Years Attended
High School: Graduated
College 1: Name, Location
College 1: Years Attended
College 1: Graduate
College 1: Subject Studied
College 2: Name, Location
College 2: Years Attended
College 2: Graduate
College 2: Subjects Studied
Trade/Business/Tech School: Name, Location
Trade/Business/Tech School: Years Attended
Trade/Business/Tech School: Graduate
Trade/Business/Tech School: Subjects Studied

General Information (Include Dates & Certifications)

Subjects of Special Study/Resarch Work
Special Training
Special Skills
U.S. Military Service

Former Employers (Most recent First)

Employer 1: Name, Location
Employer 1: Dates of Employment
Employer 1: Position + Job Description
Employer 1: Salary
Employer 1: Reason for Leaving
Employer 1: Permission to Contact?
Employer 1: Contact Information
Employer 2: Name, Location
Employer 2: Dates of Employment
Employer 2: Salary
Employer 2: Position + Job Description
Employer 2: Reason for Leaving
Employer 2: Permission to Contact?
Employer 2: Contact Information
Employer 3: Name, Location
Employer 3: Dates of Employment
Employer 3: Salary
Employer 3: Position + Job Description
Employer 3: Reason for Leaving
Employer 3: Permission to Contact?
Employer 3: Contact Information
Employer 4: Name, Location
Employer: 4: Dates of Employment
Employer 4: Salary
Employer 4: Position + Job Description
Employer 4: Reason for Leaving
Employer 4: Permission to Contact?
Employer 4: Contact Information

References: Please give the names of three persons not related to you, whom you have known for at least one year.

Reference #1: Name, Contact Information, Business
Reference #1: Years Known
Reference #2: Name, Contact Information, Business
Reference #2: Years Known
Reference #3: Name, Contact Information, Business
Reference #3: Years Known
By clicking SUBMIT MY APPLICATION button below: I certify that the facts contained in this application are true and complete to the best of my knowledge and understanding that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
This waiver does not permit the release of use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.