Application

kelsch nj application

Welcome to Kelsch Associates NJ! Thank you for applying for employment with our agency.
Please explore our website for information about the services we provide and our approach to person-centered planning.
** We are an Equal Opportunity Employer. Employment with our agency is not contracted, but is employment at will, meaning that an employee can be dismissed for any reason and without warning.

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Please note: The application cannot be saved while in progress. If you navigate away from this page, the contents of the application will be lost. Please indicate that you understand. *

general information

Name *

First

Last

Are your employment records listed under another name? Please answer yes or no. If yes, please provide list another name (First Last). *

Telephone number (###-###-####) *

Email address: *

Are you legally eligible for employment for in the U.S.A.? *

Have you ever been employed Kelsch Associates NJ? If yes, please provide dates. *

Have you have applied or been interviewed before at Kelsch Associates NJ? If yes, please specify date(s). *

Do you know anyone that currently works for Kelsch Associates NJ? *

If you do know someone working at Kelsch Associates NJ (please note who and your relationship to them)? *

**Please note that Kelsch Associates NJ has an Employee Referral Program.
If you have been referred for employment, please indicate in the field above, the name of the current staff who referred you.
By indicating their name, you are confirming their eligibility for a referral bonus.

When can you start working? *

If currently employed, how much notice must you give? If not employed, please mark N/A. *

Please list the dates of any planned vacations in the next 6 months, for which you will need to be off from work. If none, please indicate none. *

The position for which you are applying may require you to complete the following tasks and or encounter the following scenarios:

1. Pushing a wheelchair
2. Standing
3. Sitting
4. Walking
5. Climbing up and down stairs for any period of time
6. Lifting, e.g. grocery bags, gallons of milk, vacuum
7. Pushing
8. Pulling
9. Bending
10. Squatting or kneeling?
11. Painting?
12. Being exposed to household environment odors, such as, but not limited to: cleaning agents, paint fumes, tobacco smoke, etc.
13. Driving, both short distances (local) and long distances (not local)
14. Lifting and transferring with a Hoyer lift (training will be provided)

Can you perform the tasks 1-14 above, yes or no? *

If no, please explain: *

To be considered for a position, you must be 18 years of age or older. Do you acknowledge that you are 18 years old? *

A full (non-provisional), valid driver's license is required. Do you currently hold a full (non-provisional), valid driver's license? *

DHS regulations require pre-employment and random drug testing of anyone who provides direct care to any individuals with Developmental Disabilities. Successful completion of a pre-employment drug test is required, as is random testing should you be offered a position. Do you understand this requirement? *

Effective 7/5/2016: State regulations require that an original high school diploma or GED must be presented at the time of interview. Please acknowledge that you have read and understand this requirement. *

All employees are required to work at all of our locations and will be assigned and reassigned a work location as determined by administrative staff. You will, at times be "pulled" to other program locations as a temporary replacement staff, or permanently transferred to a different program location. Employees DO NOT have the option of accepting or rejecting a work assignment at a specific location. Furthermore, no transfers will be considered based on travel distance to an employee's personal residence. Our locations are in Burlington County, Camden County, and Gloucester County.

Do you agree to the working locations and criteria specified above? *

To be considered for hire, all applicants must be willing to complete the tasks below. Are you willing to complete the following? Or work with individuals who need care, support or assistance for the following reasons?

1. Change adult diapers (attends)
2. Transfer individuals using a Hoyer Lift
3. Work with individuals who have challenging behaviors

** Please note that training and support will be provided as necessary.

Are you willing to: 1. Change adult diapers (attends), 2. Transfer individuals using a Hoyer Lift, 3. Work with individuals who have challenging behaviors? *

shift assignment

Below are the schedule expectations and starting pay rates for Kelsch Associates NJ employees. In adition to a personal desire for more responsibility, which could result in a promotion; raises and promotions are given based on seniority. Holiday pay is offered for Thanksgiving, Christmas Eve, Christmas Day, New Years Eve, New Years Day, Memorial Day, July 4th and Labor Day. Please note that salaries quoted below are starting rates only.

Residential Shifts:
Full Time 2nd Shift: Hours and days scheduled vary day to day and week to week. Any amount of hours will be scheduled Monday-Friday between noon and midnight. Saturday and Sunday shifts are up to 10.5 hours, between 6:00a.m. and midnight. Weekend work is required. Scheduled off days will be weekdays; however, there may be occasional weekends off. Employees may be asked to work an occasional 3rd shift or AM shift. $14.25/hour with multiple opportunities for a raise based on seniority.

Full Time 3rd Shift: Hours and days scheduled vary day to day and week to week. Most of the 3rd shift, from start time until individuals are awake, is spent focusing on cleaning and licensing compliance. Weekend work is required; any amount of hours up to 10.5 hours between 10:00p.m. and 9:30a.m. May work four or five 3rd shifts in one week, or three or four 3rd shifts plus one or two 8-10 hour (only 10.5 hours if needed) shifts between 6:00a.m. and midnight on Saturday or Sunday on alternate weeks. $14.00/hour with multiple opportunities for a raise based on seniority.

Part Time Mid-2nd Shift: Monday-Friday. Any amount of hours between 4:30pm-10pm. $13.50/hour with multiple opportunities for a raise based on seniority.

Please indicate below your shift assignment choice.
**Please note that you should use your current availability to determine which shift best fits your lifestyle.
Kelsch Associates NJ encourages all applicants to consider all aspects of their life,
in order to afford themselves the best "home-work life" balance.

Please select your first choice of shift assignment: *

Please select your second choice of shift assignment: *

Please select your third choice of shift assignment: *

Are you currently enrolled in school *

If yes, please note the name of the school and when the semester begins and ends: *

If necessary, please indicate your school schedule, including days and times of each class that you are taking: *

Attendance at staff meetings is mandatory. Meetings are typically held for 1 hour Tuesday-Friday, every other week, between 8:30a.m. & 4:30 p.m. You may not be typically scheduled to work during these hours and may have other obligations; however it is expected that you will attend. Will you attend? Attendance is a condition of consideration for hire. *

In your first 4 months of employment, you will be scheduled to attend 5 training sessions. After initial training, you will be scheduled to attend at least one annual training session. Trainings may be on days and times when you typically do not work. Will you attend? *

per diem employment

Kelsch Associates recognizes that not everyone has the ability to commit to one of the regularly scheduled shifts (noted above) and also offers Per Diem shifts. Per Diem employment is an opportunity for the Employee to meet their other schedule obligations, while still working for Kelsch. Specifics of Per Diem employment include:

No more than 30 hours/ week
No benefits
Guaranteed 20 hour/month
All Kelsch Associates Inc NJ's policies and procedures apply
School Schedule not honored
Pay $12/hour
Trainings required

Are you interested in being considered for Per Diem employment? (*Please note that you cannot be considered for "regular" employment as well as Per Diem employment) *

prior certifications

Are you currently CPR certified. If no training will be provided. *

If yes, when does your training expire (mm/dd/yyyy)? *

Are you currently First Aid certified? If no, training will be provided. *

If yes, when does your training expire (mm/dd/yyyy)? *

Are you currently a Certified Nursing Assistant? *

Are you currently a certified Home Health Aide? *

Are you currently a Licensed Practical Nurse? *

Are you currently a licensed Registered Nurse? *

law enforcement information

Please read carefully, all information will be verified via a criminal history check

For questions 1 & 2, omit any minor traffic violations and any offense committed before your 18th birthday, which was finally adjudicated in a juvenile court or under a youth offender law.

To avoid being terminated for falsification of application, any other prior disorderly persons offense (e.g. misdemeanor) or prior criminal offense conviction or pending disorderly persons offense (e.e misdemeanor) or criminal offense (e.g. felony) charge should be documented and clarified below.

Conviction of a disorderly persons offense (e.g. misdemeanor) or criminal offense (e.g. felony) is not a bar to employment in all cases; each case will be considered on it's merits.

**Note Well: Although someone may have told you that your adult record would not be disclosed on a disorderly persons offense (e.g. misdemeanor) or criminal offense (e.g. felony) check, it may do so, if you haven't had your record "expunged". Expungement is a legal procedure requiring forms to be completed, notarized and a fee to be processed. If your record has not been "expunged" and you choose the "no" option and it is determined that you do have a disorderly persons offense (e.g. misdemeanor) or criminal offense (e.g. felony) record and you are hired, you will be terminated.

1) Were you ever convicted of a disorderly persons offense (e.g. misdemeanor) or a criminal offense (e.g. felony), or have you ever forfeited bond or collateral in connection with a disorderly persons offense (e.g. misdemeanor) or criminal offense (e.g. felony) charge? *

2) Is any disorderly persons offense (e.g. misdemeanor) or criminal offense (e.g. felony) charge pending against you currently? *

3) Have you been determined by the Department of Human Services to have abused, neglected or exploited an individual with a developmental disabilities or have you been adjudicated civilly or criminally liable for abuse, neglect or exploitation against a developmentally disabled person? *

If you have answered "yes" to questions 1, 2 or 3; please provide details in the space provided. *

4) Are you currently bound by the terms of a conditional discharge or conditional dismissal program? *

If you answered yes to number 4, please note the date and location of the offense, and the ending date for completion of your diversionary program. *

employment history

List your employment record for the past 10 years, including periods of unemployment, starting with your present position and working backwards by 10 years. Please include all paid employment, volunteer or unpaid work and any Military service which, in your opinion, helps to qualify you for the job that you want. Be sure to provide detailed information for all references.

You must include at least two references;
if you have not had at least one employer, please see the personal reference section below.

**Note well, five previous employer records have been provided,
should you need additional records, please contact our administrative office at 856-456-2022

1. Name and Address of Employer *

Name and Title of Immediate Supervisor *

Phone Number *

Dates of Employmemt (mm/yy to mm/yy) *

Position *

Have you ever been disciplined? If yes, please explain *

Explanation *

Were you terminated from employment with this company? If yes, please explain. *

Explanation *

Reason for leaving? *

How much notice did you give? *

Please provide a detailed description of your job duties and responsibilities: *

2. Name and Address of Employer *

Name and Title of Immediate Supervisor *

Phone Number *

Dates of Employment (mm/yy to mm/yy) *

Position *

Have you ever been disciplined? If yes, please explain. *

Explanation *

Were you terminated from employment with this company? If yes, please explain. *

Explanation *

Reason for leaving? *

How much notice did you give? *

Please provide a detailed description of your job duties and responsibilities: *

3. Name and Address of Employer *

Name and Title of Immediate Supervisor *

Phone Number *

Dates of Employment (mm/yy to mm/yy) *

Position *

Have you ever been disciplined? If yes, please explain. *

Explanation *

Were you terminated from employment with this company? If yes, please explain. *

Explanation *

Reason for leaving? *

How much notice did you give? *

Please provide a detailed description of your job duties and responsibilities: *

4. Name and Address of Employer *

Name and Title of Immediate Supervisor *

Phone Number *

Dates of Employment (mm/yy to mm/yy) *

Position *

Have you ever been disciplined? If yes, please explain. *

Explanation *

Were you terminated from employment with this company? If yes, please explain. *

Explanation *

Reason for leaving? *

How much notice did you give? *

Please provide a detailed description of your job duties and responsibilities: *

5. Name and Address of Employer *

Name and Title of Immediate Supervisor *

Phone Number *

Dates of Employment (mm/yy to mm/yy) *

Position *

Have you ever been disciplined? If yes, please explain. *

Explanation *

Were you terminated from employment with this company? If yes, please explain. *

Explanation *

Reason for leaving? *

How much notice did you give? *

Please provide a detailed description of your job duties and responsibilities: *

If you require additional Employment History space, please contact our main office at 856-456-2022. Do you require additional Employment History space? *

You must have a minimum of two references. If you less than two professional references, you must provide either one or two personal references, depending on how many professional references you have above.

**Please disregard this section if you have two professional references.

Name of Personal Reference *

Phone Number *

Address *

Please explain your relationship to your personal reference *

questions

Please give a detailed answer for each of the questions below. Please include specifics and be as thorough as possible.

On Friday, July 28th, you (Staff 1) are assigned to work from 6:00 am- noon. You arrive on your shift. The staff who you relieved lets you know that they attempted to wake John up; however, he stated that he was tired and wasn’t getting up for work. These are the events that happen during your shift:

At 7:50 am John wakes up, comes out of his room and says that his tooth hurts
At 8 am Tylenol is given at John’s request for a tooth ache, he returns to his room
At 9:00 am You check on John, he requests that he see his dentist
At 9:15 am You make a dentist appointment for tomorrow at 7:50 am
At 9:30 am John sits at the table and requests breakfast
At 9:35 am You offer John Captain Crunch with skim milk and a glass of water
At 9:45 am John states that his tooth hurts too much to eat breakfast
At 10:00 am While sitting at the kitchen table, John yells that his tooth is hurting. John’s roommate Tony, who is also sitting at the table tells John to, “shut up about your tooth!” You intervene.

After your intervention, you open the refrigerator to put the milk away. While doing this, John gets up from the table and approaches you. He yells, “I hate you! You’re an ugly, asshole!” and hits you with an open hand on your wrist. You are not injured.

Immediately after this interaction, John goes to his room.

At 10:30 am John is in his room sleeping.
At 11:45 am You complete your shift documentation

1. Please provide your documentation for this shift. Please include whatever facts described that you think may be relevant to letting your supervisor/other coworkers know about how John’s day went, including specifics that are alluded to but not specified in the description of the day. For example, please describe the intervention strategies you would use when Tony became upset. *** PLEASE NOTE: Copying and pasting the information from the question is not an adequate response. *

2. If you were Staff 1’s supervisor, what feedback, if any, would you give to them regarding their performance on their shift? *

If "friend" or "other", please specify *

Submit