Attention: All Aplicants

S&H Youth and Adult Services, Inc.

ATTENTION: ALL APLICANTS

S&H YOUTH AND ADULT SERVICES, INC. HUMAN RESOURCE DEPARTMENT REQUIRES THE FOLLOWING ITEMS ACCOMPANY YOUR APPLICATION

v  RESUME

v  THREE (3) LETTERS OF REFERNCE

v  AN OFFICIAL COPY OF TRANSCIPT

(Highest Degree**High School, Undergraduate, or Graduate)

v  ALL CURRENT TRAINING CERTIFICATES IN THE FOLLOWING:

·  CPR

·  First Aid

·  Blood borne Pathogens

·  Restraint Training (CPI/NCI)

·  Person Centered Planning/Thinking

·  Crisis Planning

·  Incident/Accident Reporting

·  Medication Administration

·  Seizure Management

·  Client Rights

·  MAPP-GPS

·  Motivational Interviewing

·  Cognitive Behavioral Therapy Intervention

S&H Youth and Adult Services, Inc.

EMPLOYMENT APPLICATION

Applications are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or in the presence of a non-related medical condition or handicap.

Name______Date______

Address______Phone #______

City______State_____Zip______Social Security #______

DOB______Are you a citizen of the United States of America? [ ] Yes [ ] No

Have you applied here before? [ ] Yes [ ] No When?______Position applied for?______

Start When______[ ] Full time [ ] Part time [ ] Temporary [ ] Other______

EMPLOYMENT EXPERIENCE; Start with your present job or last job. Include military assignments and other volunteer activities. Exclude organizational names which indicate race, color, religion, sex, or national origin

Employer 1______

Address______City______State_____Zip______

Phone #______Supervisors’ Name______

Job Title______Reason for leaving______

Dates of Employment: From______To______Salary or Hourly rate______

Employer 2______

Address______City______State_____Zip______

Phone #______Supervisors’ Name______

Job Title______Reason for leaving______

Dates of Employment: From______To______Salary or Hourly rate______

Employer 3______

Address______City______State_____Zip______

Phone #______Supervisors’ Name______

Job Title______Reason for leaving______

Dates of Employment: From______To______Salary or Hourly rate______

EMPLOYMENT APPLICATION PART 2

EDUCATION

Schools/Colleges Attended: # Years Year Grad. Degree

______

______

______

Describe any special qualifications for this job: (Current Certificate of Required Trainings, License(s), Experience)

______

______

______

Drivers License #______State______Expiration______

Are you a veteran of the U.S. Military service? Yes No Have you ever pled guilty or no contest to or been convicted of a crime other than a minor traffic violation? Yes No, if yes please explain

(conviction does not automatically disqualify a candidate)

______

Have you ever been substantiated for child or disabled adult abuse/neglect? Yes No, if yes please explain (substantiation does not automatically disqualify a candidate)

______

APPLICANT CONFIDENTIALITY STATEMENT OF AGREEMENT

I CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize investigations of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given on my application or interview may result in termination. I understand and agree to ensure the privilege and confidential nature of all information.

Signature______Date______

For Personnel Department only

Accurate Credit Bureau fax 626 398-0642

I wish to order [ ] Credit Report [ ] DMV Records [ ] Reference Verification [ ]Criminal Records

For Personnel Department Only

Employment and Education Verification Form

Applicant Name______

Position Applied For______

Employment Verification

Date:____/____/____

Company:______

Name& Title of Reference______

Position ______Dates of Employment______

Date:____/____/____

Company:______

mployee Training

I authorize verification of all employment and education. ______/__/__

Applicant Signature Date

I confirm verification of all employment and education. ______/__/__

SHYAS Personnel Signature Date

S&H Youth and Adult Services Inc. is dedicated to serving its clients in the most effective manner. Part of this service is a comprehensive training program that prepares employees to provide care of the highest caliber. This process is on-going but begins with a five-day orientation period that includes client contact.
S&H believes in quality service and there are on going opportunities for training as well as several annual refresher requirements for critical areas of service, such as Client Rights.
*S&H Youth and Adult Services Inc. offers the following training classes to its employees: If you have any of the following trainings please submit a copy of your certification with your employment application

·  S&H Organization Orientation

§  Role, Purpose, Philosophy of Service

§  Policy & Procedures

§  Pay and Progress

§  Vehicle Operations

§  Interaction & Communication

§  Client Rights & Responsibilities

·  Service Specific Training

§  Substance Abuse Treatment Services

§  Mental Health Treatment Services

§  Foster Care/Residential Treatment Services

·  Overview of Mental Health, Developmental Disabilities, & Substance Abuse

§  Popular diagnosis

§  Stages of Change

§  Sobriety and Mental Health Stability

·  Intervention Skills Training

§  Person Centered Thinking

§  Crisis Planning

§  Incident/Accident Response & Reporting + (IRIS)

§  CPR

§  First Aid and Seizure Management

§  Blood borne Pathogens

§  Restraint Training (CPI/NCI)

§  Medication Administration

*A Copy of All Current Certificates of Training Should Accompany Your Application*