Facebook

Resources
Wish List
Contact

About Us
Our Care
Stories
News
Apply
- Direct Support Professionals
Give

Select Page

Home / Apply

Apply

Please use our online application form below to apply.
You can also click this button to download and print the application as a PDF.

Direct Support Professionals

We are currently hiring DSPs. We would love for you to consider joining our team. No licensure or certifications required however, applicant must be 18 years old and have earned a high school diploma or equivalent. We have a new hiring wage of $15.00/hr with the potential to earn quarterly bonuses after the initial 90 day introductory period.

1

2

3

4

Application for Employment
AGAPE RESPITE CARE, INC.
298 Emmental DR., BOX 84
BERNE, IN 46711
260-589-3351

Agape Respite Care, Inc. is an equal opportunity employer. Applicants are considered for employment without regard to race, color, national origin, religion, gender, age, disability, citizenship status, or any other basis prohibited by law, unless such basis constitutes a bona fide occupational qualification. Agape Respite Care, Inc. will comply with its obligation to provide reasonable accommodation to qualified individuals with disabilities.
General Information
Date of application:*
MM slash DD slash YYYY
Position applied for:*
Your Name:*
First Middle Last
Your Email Address:*
Present Address:*
Street Address Address Line 2 City State ZIP Code
Home Phone No:*
Cell Phone No:*
Are you 18 years or older?*
- Yes
- No
List the county / counties of residence for the past three (3) years:*
Are you able to perform the essential tasks of this job with reasonable accommodations?*
- Yes
- No
Have you ever been convicted of a misdemeanor or felony?*
- Yes
- No
Are you interested in working:*
- Full Time
- Part-Time
- As Needed
Are you willing to work?*
- Days
- Evenings
- Overnight
- Weekends (Saturday and / or Sunday)
When are you available to start work at Agape Respite Care?*
Have you filed an application here before?*
- Yes
- No
If yes, give date(s)*
Have you ever been employed here before?*
- Yes
- No
If yes, give date(s)*
How did you hear about this position?*
- Website
- Referral by current employee
- Referral by someone else
- Other
Name of the person who referred you:
Explain:

Education
Did you graduate high school?*
- Yes
- No
Last year of high school completed:*
Did you get your GED?*
- Yes
- No
Name of last high school attended:*
Average grade:*
Did you graduate from college?*
- Yes
- No
Last year of college completed:
Honors:
College name & location:
Number of years:
Major:
Degree:
Business school name & location:
Number of years:
Major:
Degree:
Graduate school name & location:
Number of years:
Major:
Degree:
Other schooling or relevant training:
Skills
Have you:
worked with persons who are intellectually disabled?*
- Yes
- No
worked with persons who are physically disabled?*
- Yes
- No
worked with persons who are deaf or blind?*
- Yes
- No
worked with persons who have Alzheimer’s or dementia?*
- Yes
- No
If yes describe your experience:*
Why are you interested in working at Agape Respite Care?*

Employment Record
Starting with your present or most recent job, list your employment experience. You may include job-related military service assignments and volunteer activities that reflect your qualifications for employment. Do not omit any employment.
Company 1
Company name:*
Company Address*
Street Address Address Line 2 City State ZIP Code
Company Phone:*
May we contact this employer?*
- Yes
- No
If no, explain why:*
Job Title:*
Employment Dates (Example: Jan 2018 - Dec 2020):*
Job duties performed:*
Reason for leaving?*
Additional Positions
How many more positions would you like to list?*
Company 2
Company name:*
Company Address*
Street Address Address Line 2 City State ZIP Code
Company Phone:*
May we contact this employer?*
- Yes
- No
If no, explain why:*
Job Title:*
Employment Dates (Example: Jan 2018 - Dec 2020):*
Job duties performed:*
Reason for leaving?*
Company 3
Company name:*
Company Address*
Street Address Address Line 2 City State ZIP Code
Company Phone:*
May we contact this employer?*
- Yes
- No
Company name:*
May we contact this employer?*
- Yes
- No
If no, explain why:*
Job Title:*
Employment Dates (Example: Jan 2018 - Dec 2020):*
Job duties performed:*
Reason for leaving?*
Expected Salary/Wages
For this position I would expect a salary / hourly wage of*

References
INCLUDE A MINIMUM OF THREE REFERENCES. Please provide professional references and persons who are capable of evaluating your work performance. One reference may be a personal reference (please do not include family members or anyone you are in a dating relationship with).
Reference 1
Name*
First Last
Relationship:*
How long have you known this person?*
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Reference 2
Name*
First Last
Relationship:*
How long have you known this person?*
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Reference 3
Name*
First Last
Relationship:*
How long have you known this person?*
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Work Availability
Please note:
- Your application for employment will not be considered without completion of this form at the time of application.
- We expect that the availability indicated in this section will remain in effect for at least 90 days after date of hire. Any deviation from this availability or requested time off must follow the guidelines as laid out in our personnel policies.
All applicants for Direct support staff are required at the time of application to declare all hours they are available to work along with the maximum number of hours they are willing to work. Please keep in mind that service at the Agape Respite House is often 24 / 7 and weekend availability is a must. If the applicant’s availability does not meet the needs of Agape Respite Care, he or she will not be interviewed or hired.
I am available (maximum number of hours per week):*
Times available to work:
Please complete the second table with your hours of availability. (Example - Monday: All day, except 11 am – 2 pm)
Monday*
Tuesday*
Wednesay*
Thursday*
Friday*
Saturday*
Sunday*
Name
This field is for validation purposes and should be left unchanged.

About Us

Mission & Values
History
Facilities
Staff
Board of Directors
FAQ

Our Care

Respite
Participant Assistance in Care
Limited Residential Habilitation
Community Habilitation
Programs

Helpful Links

Resources
Apply
Volunteer
Give
Contact

© 2023 Agape Respite Care | Privacy Policy | Contact | Developed by Sprunger Design