Reach Their Fullest Potential

Carobell, Inc.

Empowering Members to

Applicants, please carefully read the letter on the following page. It is intended to give you a realistic preview of what a position with Carobell is like. After doing so, if you wish to proceed with the application process, please complete all the remaining pages and return this packet to Carobell’s Human Resources Department.

We appreciate your time and your interest in Carobell.

Vanessa Ervin, CEO

Carobell, Inc.

Empowering Members to

Reach Their Fullest Potential

Dear Habilitation/Vocational Technician Applicant:

Let me thank you for taking the time and making the effort to apply for a position with us today. Carobell and Station Club are uncommon places that provide each of us the opportunity to support the unique members that live in one of our homes, attend one of our day programs and/or receive services in their own home. I feel confident in saying that you will find Carobell and Station Club to be welcoming, supportive and uplifting places.

Working with memberls with moderate to severe developmental disabilities can be extremely rewarding and extremely difficult. The purpose of this letter is to give you a realistic look at what you will encounter if you should come to work with us in order for you to be able to make an informed decision as to whether or not you’d like to continue the application process.

The rewards come from getting to know and assist the members you support. They come from a smile, a touch, a sound. They come from knowing that you can and will make a positive difference every day.

What can make this work difficult are quite simply the issues that are just part of being human. If you should come to work with us, you will be doing physical work that requires lifting (with co-workers and with mechanical lifts), stooping, bending, sitting, pushing, driving, etc. You will also, on a regular basis, be assisting adult men and women with their personal needs which include toileting and bathing. In addition, you will be supporting members that are incontinent and wear adult briefs (i.e. Attends). To speak plainly, you will be assisting adults with personal care who have defecated and urinated on themselves. And, as is true with all humans, the members you support will on occasion become ill and vomit. If you feel that you can deal with the issues above in a professional, dignified and calm manner, please keep reading to learn more.

If you are an applicant for a position working in one of the houses at Carobell (habilitation technician), please be aware that we are open 24 hours a day, 7 days a week, 365 days per year which includes weekends and holidays. You will be hired to work one primary shift; however, you will be assigned to work other shifts based on the needs of the organization. If you are not able to work varying shifts, weekends and holidays you should not apply for a habilitation position. In addition, vocational technicians are required to work some evening and weekends providing in home services.

If by this time you have not been scared off and you think you can meet our high standards, please complete the attached application and submit it to human resources in person or at .

Sincerely,

Richard E. Walker

Human Resources Director

Carobell, Inc.

Empowering Members to

Reach Their Fullest Potential

DRIVING RECORD

All employees of Carobell will, on occasion, be required to drive a Carobell or personal vehicle as part of their work here. Please answer the following questions concerning your driving record by circling the correct answer. Should you be hired for a position at Carobell, a thorough motor vehicle check will be performed.

Do you have a current, valid driver’s license?

YesNo

If the answer is no, please explain:

______

In the past three years have you had two or more moving motor vehicle violations?

YesNo

If yes, please provide type of violation and dates

______

In the past 7 years have you been convicted of DWI/DUI, leaving the scene of an accident, reckless driving or other similarly serious driving offense?

YesNo

If yes, please provide type of violation and dates

______

EMPLOYMENT APPLICATION

Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status.

Position Applying For: / Date:
Name:

LastFirstMI Other Name(s) Used for Employment

Address:

StreetAddressCityState Zip Code

Social Security #: / Driver’s License #:
Daytime Phone #: / Alternate Phone #:
Email: / Alternate Email:
Yes No
Were you previously employed by us? / If so, when?
Have you previously applied here? / If so, when?
Are you related to anyone employed here? / If so, whom?
Are you legally eligible for employment in the USA?
Other than minor traffic violations, have you ever / If so, please provide detail:
been convicted of a crime?*
Have you ever had a substantiated claim against / If so, please provide detail:
you in regards to your caring for others in a pro-
fessional setting*
Have you ever had a registration, certification, or / If so, please provide detail:
professional license revoked?*

*A conviction or revocation of licensure/certification/registration will not necessarily preclude you from employment. The entirety of the situation will be assessed. Please note that failure to disclose such information, however, will lead to termination.

EDUCATIONAL DATA

School Name / City / State / Diploma/Area of Degree
High School:
College:
Voc/Tech:
GED:
Do you hold a certification or licensure in North Carolina? / No / Yes
If yes, list #: / Type:
Certain positions within our organization are subject to short notice for hours of duty. Would transportation be
available to you at all times? / No / Yes
Certain positions within our organization have the requirement of availability for all three shifts as well as Saturday
and Sunday. Would this be a problem for you? / No / Yes / If yes, why?
Date Available to Work: / What shifts are you available to work? / 7-3 / 3-11 / 11-7
I am looking for: / Full Time / Part Time / Either

List training, experiences, skills or qualifications which you feel would especially fit you for work with individuals who havedevelopmental disability diagnoses and multiple handicaps:

Certain positions at Carobell require employees to lift up to 40 pounds without assistance. Can you perform
this task? / No / Yes
Certain positions at Carobell require employees to lift over 40 pounds with assistance. Can you perform this
task? / No / Yes

EMPLOYMENT RECORD

List all past employment, starting with most recent employer. Use additional sheet if necessary.

Name and Address
Of Previous Employer / Type of Work / Dates Employed / Reason for
Leaving
From / To

List places of residence for the past five (5) years starting with current residence:

Length of Time / Street Address / City / State / County

State briefly why you want to work at Carobell:

AUTHORIZATION AND RELEASE OF INFORMATION

PLEASE READ CAREFULLY BEFORE SIGNING BELOW

I certify that all statements made in this application are true, complete and correct to the best of my knowledge and belief and are made in good faith. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal.

I hereby authorize Carobell, Inc. to make any investigation concerning my past employment history, driving record, personal references, criminal record and other statements contained in this application.

Employees of Carobell are hired “at-will.” An agreement to hire does not constitute a legal contract.

Our standards require a criminal background check on all prospective employees. Employment is contingent upon satisfactory completion of employment check, screening tests (including a drug screen) and other hiring requirements.

I hereby acknowledge that I have been informed that as of January 1, 2012 all Carobell locations, campuses and vehicles will be smoke free and that, dependent upon staffing levels and client needs, I may not be able to smoke during my entire work shift.

Signature of ApplicantDate

Rev: 10/23/17

Carobell, Inc.

Empowering Members to

Reach Their Fullest Potential

References Page

Please provide 3 professional (from former employers) references below. If you do not have this information with you now, you may email the information to .

Please keep in mind that we will not be able to move forward in the hiring process until we receive this information from you. We also recommend that you contact each reference to let him/her know that he/she will be receiving a reference request from Carobell Human Resources and that it is important to you that they complete the reference process as quickly as possible.

Reference 1:
Name ______
Phone ______
Relationship to you (check 1):
Former/current supervisor or instructor
Former/current co-worker
Other ______/ Reference 2:
Name ______
Phone ______
Relationship to you (check 1):
Former/current supervisor or instructor
Former/current co-worker
Other ______
Reference 3:
Name ______
Phone ______
Relationship to you (check 1):
Former/current supervisor or instructor
Former/current co-worker
Other ______

To the References Above:

I ______(Please Print Your Name) have applied for employment at Carobell, Inc. I authorize you to render the opinions and form the judgments and provide them with the information requested in connection with my employment/association with you and possible employment with them. I hereby release you and/or your company from all liability whatsoever as a result of the completion of this reference.

Social Security Number / Signature of Applicant / Date