STRIVE Job Application

STRIVE Job Application

Join Our Team

In compliance with Federal and State Equal Employment Opportunity Laws, all qualified candidates will be considered for employment without regard totheir race, creed, color, national origin, ancestry, sex, age, marital status, veteran status, sexual orientation, or the presence of non-job relatedmedical conditions or disabilities.
Today's Date:
Date Available for Work:
First Name *:
Last Name *:
Primary Phone #:
Email *:
Current Address:
City/Town:
State:
ZIP code:
How long at current address?:
Previous Addresses (at least 10 years): First Previous Address
First previous address:
City/Town:
State:
ZIP code:
How long at the first previous address?:
Next previous address:
City/Town:
State/Province:
ZIP code:
How long at the next previous address?:
Available to work
Program Desired
Hours available (please specify times):
Do you have a DSP Certificate:
Do you have an MHRT I or an MHRT Provisional?:
Do you have
A clean driving record? (This includes all tickets and accidents):
Are you 18 years or older?:
Have you ever been convicted of a crime?:
There are instances in which federal or state law, regulation, or rule mandates that a criminal conviction disqualifies an applicant from a position, imposes an obligation on an employer not to hire an applicant who has been convicted of a certain type of offense, or requires that an employer conduct a criminal history record check. We do conduct criminal history record checks and are mandated to not employ individuals with certain convictions, for example, assault and other crimes against people. Some convictions, while not a definite disqualifier, will need to be assessed on an individual basis.
Have you ever been investigated for abuse or neglect of an individual? :
Have you ever applied for work at this company before? :
How were you referred to us? :
Highest level of education completed:
School name and address of highest level of education completed:
Course/Major of highest level of education completed (if applicable):
Proof of education is required for employment with PSL Services/STRIVE. Are you able to provide documentation in the form of diploma, transcripts or written verification from institution of the above listed information? :

EMPLOYMENT:

If you have never been employed, please type in names of non-relatives who may be contacted for references. If you are attaching a resume, please complete the sections not covered in your resume.
Are you currently employed?:

Current or last employer:

Dates to position and duties of current/last employer:
Company Name and Address of current/last employer:
Supervisor's name and title (current/last employer):
Current/last employer phone number:
Current/last employer email address:
Reason for leaving (if last employer):

Previous Employment

Dates to position and duties of previous employer:
Previous employer company name and address:
Supervisor's name and title (previous employer):
Previous employer phone number:
Previous employer email address:
Reason for leaving previous employer:
May we contact all the previous employers listed above?:
Professional References (please list at least three):
All professional references (in the text box above) should include name, address or email address, phone number, and the relationship of the reference.
Personal References (please list at least three):
All personal references (in the text box above) should include name, address or email address, phone number, and the relationship of the reference.

Please list all trainings and current certifications relevant to position applied for:

Direct Support Professional

MHRT I

Completed on
MHRT I Expiration (or N/A)
MHRT I Trainer or Agency

MHRT Provisional

Completed on
MHRT Provisional Expiration (or N/A)
MHRT Provisional Trainer or Agency

First Aid

Completed on:
First Aid Expiration (or N/A):
First Aid Trainer or Agency:

CPR

Completed on:
CPR Expiration (or N/A):
CPR Trainer or Agency:

CRMA (24 Hour)

Completed on:
CRMA (24 Hour) Expiration (or N/A):
CRMA (24 Hour) Trainer or Agency:

CRMA (40 Hour)

Completed on:
CRMA (40 Hour) Expiration (or N/A):
CRMA (40 Hour) Trainer or Agency:
Other relevant certificates:
Please use the space below to summarize any additional information necessary to describe your full qualifications:

Applicant's Certifications and Agreement and Authorization for Background Checks Please read carefully

The distribution or receiving of this application by Peregrine Corporation does not imply or intend to imply an agreement or contract to employ the applicant. The purpose of this application is solely to allow persons a standardized form on which to submit their qualifications. This application will be considered valid for no longer than one year. Reapplication is necessary after one year.
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I hereby authorize you to make any investigation of any personal/employment history record including the use of investigative agencies or bureaus of your choice. This report may include information as to my character, general reputation, and personal characteristics. I hereby authorize Peregrine Corporation to complete a criminal, Department of Human Services, and Motor Vehicle Background Check as part of its consideration of my application for employment. I further authorize appropriate authorities and the State of Maine Department of Human Services Child Protective Services to release any pertinent information to Peregrine Corporation about myself. I authorize previous employers, schools which I attended, and character references to provide information pertaining to my contact with them. I further authorize Peregrine Corporation to get my employment records. I understand that should any information relating to incidents in my past which may affect my relationship with the clients in the program, the staff, or the operation of the program be uncovered, such information may be considered sufficient reason to reject my application for employment or immediate termination. I understand that, if employed, falsified statements or material omissions on my application or resume shall be considered sufficient cause for dismissal. I also understand that if offered employment, I must prove my identity and my eligibility to work in the United States prior to being employed. I hereby acknowledge that any employment relationship with Peregrine Corporation is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood this "at will" employment relationship may not be changed by any written document or conduct unless such change is specifically acknowledged in writing by the Executive Director of Peregrine Corporation. I further authorize Peregrine Corporation to get my employment records. I understand that should any information relating to incidents in my past which may affect my relationship with the clients in the program, the staff, or the operation of the program be uncovered, such information may be considered sufficient reason to reject my application for employment or immediate termination. I understand that, if employed, falsified statements or material omissions on my application or resume shall be considered sufficient cause for dismissal. I also understand that if offered employment, I must prove my identity and my eligibility to work in the United States prior to being employed. I hereby acknowledge that any employment relationship with Peregrine Corporation is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood this "at will" employment relationship may not be changed by any written document or conduct unless such change is specifically acknowledged in writing by the Executive Director of Peregrine Corporation.
Name of applicant:
Names which you previously used:
Signature (type full name here):
Date:
Applicant will also be asked to sign a physical/hard copy of the application in the presence of PSL Services/STRIVE team member
Attach Resume- PDF, DOC, DOCX files are accepted. If on a smartphone, a clearly taken photo is also accepted
Choose File: