Employment Opportunities

We’re looking for individuals passionate about care and mental health advocacy.

Available Positions

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Step 1 of 12

URL

This field is for validation purposes and should be left unchanged.

Important:

Please read and complete the application in its entirety. Applicants who have not fully completed the employment application will not be considered for employment.

Today's Date*

MM slash DD slash YYYY

Position Applying for:*

Personal Information:

First Name:

Middle Initial &/or Maiden Name :

Last Name:

Are you known to schools, references/past employers by another name?

Yes, If yes, please print that name below.

First Name:

Middle Initial &/or Maiden Name:

Last Name:

Home Phone Number

Work Phone Number

Cell Phone Number

Current Address:

Street Address

Email Address:

How long have you lived at the above address?

Have you lived out of the state of NC in the past 7 years?

General Information:

Have you ever made application for employment with Our Company either full time or part time?

Yes

Have you made application for employment with Our Company in the last 90 days either full time or part time?

Yes

Have you ever been employed with Our Company either full time or part time?

Yes

Do you have a valid driver’s license? If no, please explain why below.

Yes

No North Carolina Drivers License?

What is your means of transportation to work?

Car

Other

Have you ever been convicted of a crime or have any pending charges? If yes, please explain below.

Yes

Explanation of conviction / pending charges:

Employment History starting with the most recent employer:

Do you have two years of supervised experience in Mental Health, Developmental Disabilities, and/or Substance Abuse?*

No. If no please go directly to Next( section B)

Yes. If yes please complete section A and B

(If additional space is needed please write on the back of this form.)

Section A.

Supervision history starting with the most recent:

Indicate MH, DD, or SA

Supervisor's Name

Supervisor's Title

Company and Phone Number

Number of Months Supervised

Indicate MH, DD, or SA

Supervisor's Name

Supervisor's Title

Company and Phone Number

Number of Months Supervised

Indicate MH, DD, or SA

Supervisor's Name

Supervisor's Title

Company and Phone Number

Number of Months Supervised

Indicate MH, DD, or SA

Supervisor's Name

Supervisor's Title

Company and Phone Number

Number of Months Supervised

Employment History starting with the most recent employer:

Section B.

Employer:*

Type of Business:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number:

Job title:

Supervisor’s Name:

Job description:

Start Date:

MM slash DD slash YYYY

End Date:

MM slash DD slash YYYY

Final Wage:

Reason for leaving:

May we contact this employer?

Yes

Employer:

Type of Business:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number:

Job title:

Supervisor’s Name:

Job description:

Start Date:

MM slash DD slash YYYY

End Date:

MM slash DD slash YYYY

Final Wage:

Reason for leaving:

May we contact this employer?

Yes

Employer:

Type of Business:

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number:

Job title:

Supervisor’s Name:

Job description:

Start Date:

MM slash DD slash YYYY

End Date:

MM slash DD slash YYYY

Final Wage:

Reason for leaving:

May we contact this employer?

Yes

Students please list clinical & educational references with which you have had considerable contact:

References:

Name:*

Occupation:

Phone #’s Home

Work

Cell

How do you know the above reference?

Name:*

Occupation:

Phone #’s Home

Work

Cell

How do you know the above reference?

Name:*

Occupation:

Phone #’s Home

Work

Cell

How do you know the above reference?

Work Availability:

When Can You Start?*

Phone Number:

Home

Cell

How many minutes are you willing to drive to work with a client?

Day of the Week

Monday

Day of the Week

I can work the hours indicated below.

10 a.m. until 8 p.m.

I can work the hours indicated below

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

**Special Needs (example: can’t work first Monday of every month).Continue on the back of this form if needed**

Licensure:

Please answer the statements below:

Licensure Information*

Current Malpractice Insurance Coverage

Indicate any history of loss of license, insurance, and felony convictions against your license

Indicate any history of loss or limitation of privileges or disciplinary activity against your license

Statement:

Applicant Agreement & Acknowledgment

Please read the following statement carefully and indicate if you understand and agree.

In submitting this application, I understand that:

The submission of this application is not a promise (implied or otherwise) of an interview or employment.
A pre-employment interview is not a promise (implied or otherwise) of employment.
A final offer of employment will be based on the results of a medical examination, background check, motor vehicle check, and possible drug screening. In addition, I must provide evidence of my education, automobile insurance, and valid driver’s license.
Any misrepresentation of facts in this application or in connection with any medical examination will be just cause for rejection of my application.
If hired, I will be utilizing my vehicle for Our Company and I am responsible for maintaining liability, comprehensive, and collision insurance on my automobile.
I understand that if hired, my hourly wage includes mileage.
I understand that Our Company does not guarantee a specific work schedule or job assignment.
As a condition of employment, Our Company requires that its employees:
- Sign up for Payroll Direct Deposit.
- Maintain a valid driver’s license.
- Maintain required trainings and certifications.
- Communicate any changes and/or incidents concerning the consumer with management staff.
- Communicate any changes with my driver’s license or auto insurance.
I understand that as a courtesy, Our Company offers free OSHA, EBPI, CPR/First Aid certifications. I understand that I have the option to take these trainings elsewhere at my own expense.
I understand that I am responsible for payment of my annual physical.
The physical demands of the job require duties to be conducted in various environments including, but not limited to, a participant’s work site, school, or home. I must be able to stand, sit, drive, and walk for extended periods of time. I must be able to lift and carry 50 or more pounds and perform duties in various weather conditions.

I hereby acknowledge that I have read and understand the above statements (1 through 11) and have not misrepresented the facts on this job application.

Below, I am attesting to the correctness and completeness of this application.

I understand and agree to the statements above.

Name*

Date

MM slash DD slash YYYY

Equal Opportunity Employer Statement

We are an Equal Opportunity Employer.

We do not condone unfair treatment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age (40 or older), disability, or genetic information.

Date of birth is required from all applicants to facilitate a background check.

Consumer Reports Release

In connection with my application for: a) employment (including contract for services), or b) residency, I understand that consumer reports or investigative consumer reports, which may contain public record information, will be made on me including: consumer credit, criminal records, driving record, education, prior employer verification, workers compensation claims, and others.

These reports will include experience along with reasons for termination of past employment. Further, I understand that you will be requesting information from various Federal, State, and Local agencies regarding my past activities.

I hereby authorize, without reservation, any party or agency contacted by this employer to furnish the above-mentioned information.

I understand I have the right to make a request of the Consumer Reporting Agency, upon proper identification and the payment of any authorized fees, for the information in its files on me at the time of my request.

I further authorize ongoing procurement of the above-mentioned reports at any time during my employment (or contract).

Please PRINT the following information

Name*

Maiden

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Years at above Residence:

Date of Birth:

MM slash DD slash YYYY

Previous Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Years at above Residence:

Signature:*

License Number

Consent to Release Information:

Employment Application

Print Applicant or Employee Name*

Date*

MM slash DD slash YYYY

Signature of Applicant’s or Employee’s*

Date*

MM slash DD slash YYYY

Our Company:

Authorization & Reference Verification

I understand that, as a condition of my consideration for employment (or continued employment) with Our Company, employment references may be contacted by phone, fax, or other means.

References will not be limited to employment history, but may also include education verification, Social Security verification, criminal and civil history, personal interviews, DMV records, public records, and any other information bearing on character, general reputation, personal characteristics, and trustworthiness.

I understand the above statement, and I hereby authorize and consent to Our Company’s procurement of such information.

What You Will Need To Be Considered For Employment:

Completed Application

Resume

Authorization for Release of Information

Criminal Record Check

MVR Report

Valid NC Drivers License

Proof of Automobile Insurance

Social Security Card or Birth Certificate

Completed I-9 Form

Proof of Education

High School Diploma, College Diploma & Transcript

or Highest Level of Education (Diploma & Transcript)

Three References Confirming That You Are Eligible For Employment

Current Physical

CPR/1st Aid

Valid NC Driver’s License is Required within 90 days if employment is offered and accepted

If you are hired you will need to provide a voided check for direct deposit.

Print Applicant’s Name:*

Date*

MM slash DD slash YYYY

Applicant’s Signature:*

Date*

MM slash DD slash YYYY

Employment Application Questionnaire

Name:*

Date*

MM slash DD slash YYYY

1.) Why are you interested in working with individuals with intellectual and developmental disabilities?

2.) What qualities do you possess that would make you a good fit for our agency?

3.) How would you handle an emergency situation with a client? What protocol would you take? Please be specific!

Personnel Requirements Policy

Annual Physical Examination Policy

As per the Personnel Requirements Policy established by Kerr Homes in 2005 and updated in August 2021, all Kerr Homes direct-care personnel must complete an annual physical with a licensed physician.

Section 3.0, paragraph nine establishes the following requirement for all direct-care employees:

Kerr Homes will ensure that each staff member who provides care or services to members is physically able to complete job responsibilities as determined by an annual physical exam.

Employees must complete a routine physical exam through their physician and submit documented results to Human Resources before the anniversary of their hire date.

Employees whose primary responsibilities involve the health and safety of our members must themselves remain healthy and physically capable. Failure to comply with this annual requirement may result in:

Suspension and removal from the service schedule until Human Resources identifies the employee as back in compliance.

The signature below certifies that the employee understands and accepts the Personnel Requirements Policy as it relates to completing an annual physical.

Staff experiencing difficulty scheduling an annual physical may contact Human Resources for a list of providers.

Newly hired staff have 90 days to complete a physical exam with a physician. Please note that, upon hire, Kerr Homes will accept a physical that is not greater than one year old.

Additional Required Documentation

Uploaded files cannot exceed 1MB in size.
Uploaded files or attachments must be in one of the following file types: JPG, GIF, PNG, or PDF.

Driver License

Max. file size: 1 GB.

Diploma – Highest Level of Education

Max. file size: 1 GB.

Car/Automobile Insurance

Max. file size: 1 GB.

Staff's Printed Name*

Date*

MM slash DD slash YYYY

I certify that I understand and accept the Personnel Requirements Policy as it relates to completing an annual physical.**

Yes