APPLICATION INSTRUCTIONS:
RCBC, INC thanks you for your interest in our Level III Residential Treatment Facility. We are in search of the most qualified and best suited people to join our team. Our clients are children between the ages of 7-18, and their families, custodians, and legal guardians.
Unfortunately, we will not be able to hire everyone that fills out an application. However, every application will be fully considered, and you will be notified by mail of our decision.
The following directions are provided to help each applicant fully and properly complete the application, as required by RCBC, INC. It is to your advantage that you carefully read the provided instructions before completing this application.
1. Use a black ink pen or a typewriter
2. Answer each question in a completed format that does not allow for speculation or guessing.
3. A resume is not a substitution for the completion of this application.
4. “SEE RESUME” is an acceptable option for questions relating to employment and education. However, be sure that the resume provided is an effective representation of the areas of reference. We are requesting COMPLETE and ACCURATE information regarding job titles, duties / responsibilities, part-time vs. full-time status employment history, and reasons for changes in jobs.
5. All completed educational endeavors must be accompanied by certificates of completion and sealed copies of transcripts for degrees earned must be provided.
6. If you do not understand a section or question on this application, please contact us. If you leave any part incomplete, your application will not be considered.
7. Applications that are not signed and dated will not be considered.
8. All applicants are subject to the Drug and Alcohol Free Policies adopted by RCBC, INC. We are committed to a drug and alcohol free environment. Any applicant who refuses a drug screening will be denied employment with RCBC, INC.
9. All applicants will be denied employment if his / her drug screening is positive of illegal substances. Also, prescribed medications that may limit ones ability to perform the duties and obligations dictated by RCBC, INC will also be denied employment.
10. Each applicant will be notified of the necessity of a complete health physical. This physical should be completed by a medical doctor, and inclusive of all medical diagnosis, medications (with identified side affects), and limitations.
11. All applicants are subject to a criminal conviction disclosure, which warrants each applicant to disclose any criminal convictions that extend beyond minor traffic violations.
12. All applicants are subject to criminal searches for history of charges regarding sexual offenses and charged cases of child abuse and / or neglect.
13. All applicants who would like to attach a letter of explanation regarding questionable history are encouraged to submit such an explanation. However, the final decision of employment with RCBC, INC relies solely with the executive officers of RCBC, INC. We maintain the right to deny employment to any applicant.
RCBC, Inc. PO Box 570
117 Old Mountain Rd.
Troutman, NC 28166-0570
(704) 528-2044 (office); (704) 528-2077 (fax)
APPLICATION FOR EMPLOYMENT:
Date:______
Last Name First Middle Name
Street Address
Mailing Address (If different from Street Address)
Home Phone Number Other Contact Number
( ) Yes ( ) No - -
Date of Birth Are you a U.S. Citizen Social Security #
Position I Applied for:
Position II Applied for:
Criminal Disclosure: The space below has been provided for brief explanations of any criminal convictions that extend beyond minor traffic violations. If you are uncertain as to the interpretation of a minor traffic violation, please contact our office.
Have you ever been convicted of a crime: ( )Yes ( ) No
If the answer is YES, please explain:
Have you ever been convicted of a felony: ( ) Yes ( ) No
If the answer is YES, please explain:
Have you ever been mandated to register as a sex offender: ( ) Yes ( ) No
If the answer is YES, please explain:
Have you ever been charged with child abuse or child neglect: ( )Yes ( ) No
If the answer is YES, please explain:
EDUCATIONAL SUMMARY:
School Name Location Major Dates Attended Graduated? Degree
HIGH SCHOOL: FROM TO ( ) YES
( ) NO
COMMUNITY COLLEGE /
TECHNICAL SCHOOL
COLLEGE OR UNIVERSITY
COLLEGE OR UNIVERSITY
OTHER TRAINING /
CERTIFICATES w/ verification
PROFESSIONAL MEMBERSHIPS
SPECIAL SKILLS: The space below is provided for applicants to identify any special skills regarding computer training skills, foreign language, transcription, or other:
Date available for employment:______
Can you work _____full-time _____part-time ______temporary
Can you work flexible shifts? ______Yes ______No
Can you work weekends? ______Yes ______No
Can you work 12 hour shifts? ______Yes ______No
Do you have a valid NC driver’s license? ______Yes ______No
Do you have any physical limitations that have either been self-identified or specified by a physician? If so, please explain:
Are you physically able to provide crisis interventive restraints on a client if deemed necessary?
If no, please explain:
Although the administrators of RCBC, INC will make every effort to accommodate individual preferences, there may be occasions and / or conditions that make it impossible to acknowledge every request. The following request may be mandatory on occasion: Weekend work, holiday work, overtime work, or on-call work / crisis response.
Please initial if you understand and accept the conditions identified above: Initial: ______; If you are unable to fully agree, please give a brief statement as to your reasons.
EMPLOYMENT RECORD: Starting with your current employer or your most recent employer, list all previous employers, including self-employment and summer and part-time jobs. Notice the face sheet of this application for clarity of the SEE RESUME option.
EMPLOYER NAME TYPE OF ORGANIZATION POSITION HELD
ADDRESS PHONE #:
( ) YES ( ) NO
SUPERVISOR’S NAME DID YOU SUPERVISE OTHERS? if yes, how many
DATE EMPLOYED DATE STARTING ENDING REASON FOR LEAVING
SEPARATED SALARY SALARY
May we contact your present employer: ( ) YES ( ) NO
List your duties in order of their importance in each job:
EMPLOYER NAME TYPE OF ORGANIZATION POSITION HELD
ADDRESS PHONE #:
( ) YES ( ) NO
SUPERVISOR’S NAME DID YOU SUPERVISE OTHERS? if yes, how many
DATE EMPLOYED DATE STARTING ENDING REASON FOR LEAVING
SEPARATED SALARY SALARY
List your duties in order of their importance in each job:
EMPLOYER NAME TYPE OF ORGANIZATION POSITION HELD
ADDRESS PHONE #:
( ) YES ( ) NO
SUPERVISOR’S NAME DID YOU SUPERVISE OTHERS? if yes, how many
DATE EMPLOYED DATE STARTING ENDING REASON FOR LEAVING
SEPARATED SALARY SALARY
List your duties in order of their importance in each job:
EMPLOYER NAME TYPE OF ORGANIZATION POSITION HELD
ADDRESS PHONE #:
( ) YES ( ) NO
SUPERVISOR’S NAME DID YOU SUPERVISE OTHERS? if yes, how many
DATE EMPLOYED DATE STARTING ENDING REASON FOR LEAVING
SEPARATED SALARY SALARY
List your duties in order of their importance in each job:
U.S. Military Record:
Branch of Service From To
Present Military Affiliation:
( ) None ( ) Reserve ( ) Active Duty ( ) Rank attained Type of Discharge
PROFESSIONAL REFERENCES: Two of your professional references must be previous supervisors and one person not related to you who can qualify as a character reference.
Name Title / Relationship Occupation
Address Phone #
Name Title / Relationship Occupation
Address Phone #
Name Title / Relationship Occupation
Address Phone #
Date available for employment:______Salary requested: ______
If I am hired, I agree to conform to the policies, rules, regulations, directions, and instructions of RCBC, INC, that are established solely for the purpose of safely managing a therapeutic residential treatment facility. I understand that no harsh or unreasonable duties will be required of me, nor will I be allowed to dictate any harsh, cruel, or unreasonable acts on another, whether that is a client or fellow staff person. INITIAL: ______
I hereby certify that all the answers provided in this application are true and correct. I understand that any misrepresentation or omission of facts on my part is sufficient justification for non-hire, or termination from RCBC, INC. I understand that my employment may be contingent upon proof of U.S. Citizenship, verification of birth, and / or any other pertinent information bearing upon my employment. Circumstances that occur during employment may affect continued employment with RCBC, INC.
Applicant’s Signature Date
For Office Use Only:
References Checked:
Date Checked: Reference #: Date Check: Reference #:
Date Checked: Reference #:
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