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Employment application

Residential staff assists with activities of daily living such as meals, medications, personal care, exercise, leisure and recreational activities, and community events as outlined in the plan of care. Applicants must be of legal age to complete job requirements, possess a valid driver license, and receive criminal background clearance upon hire.

COUNTERPOINT IS AN EQUAL OPPORTUNITY EMPLOYER

Job Application Form

Contact Info

First Name

Email

Last Name

Phone

Street Address

Street Address Line 2

City

State/Province

Postal / Zip code

Country

EMPLOYMENT

Date Available

Have you every applied for a job here before? *

Yes

No

Have you every been employed here before? *

Yes

No

Do you have a valid Montana Driver's License? *

Yes

No

Type of Work you will accept. Check all that apply.

Full Time

Part Time

Substitute

Weekends

Morning Hours (6am-9am)

Daytime Hours (8am-5pm)

Evening Hours (4pm-10pm)

Overnight Hours

Education

Name & Location of High School

Degree/Certicate

Name & Location of College/University/Vocational School

Major/Minor Field of Study

Degree/Certicate

Skills

Check all the skills or certificates that you have:

CPR

First Aid

Computer

10 Key

Manual Sign Language

DDCPT or Equivalent

MANDT

Medical Certification

Other

Employment experience

Start with your present or last job and go back a minimum of (5) years, listing former employers.

You may include military service assignments and volunteer activities.

1. Employer's Name & Location

Job Title

Supervisor's Name

Employer's Phone #

Wage/Salary

Start and End Date

Duties Performed

2. Employer's Name & Location

Job Title

Supervisor's Name

Employer's Phone #

Wage/Salary

Start and End Date

Duties Performed

3. Employer's Name & Location

Job Title

Supervisor's Name

Employer's Phone #

Wage/Salary

Start and End Date

Duties Performed

4. Employer's Name & Location

Job Title

Supervisor's Name

Employer's Phone #

Wage/Salary

Start and End Date

Duties Performed

5. Employer's Name & Location

Job Title

Supervisor's Name

Employer's Phone #

Wage/Salary

Start and End Date

Duties Performed

Professional References

(Most recent supervisors or instructors required. Do not list friends or relatives.)

1. Reference Name

Company

Relationship

Phone

2. Reference Name

Company

Relationship

Phone

3. Reference Name

Company

Relationship

Phone

I hereby authorize Counterpoint, Inc. to inquire as to my record with any or all of my former employers with no liability arising therefrom.

I hereby certify that all information above is true and complete to the best of my knowledge. I am aware that falsification or misrepresentation of required information is grounds for dismissal or disqualification from employment with Counterpoint, Inc.

Connect

Contact Us

116 East Lewis St.

Livingston, MT 59047

Phone/Fax: 406-222-2472

resdir@counterpointinc.org vocdir@counterpointinc.org

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