QIDP / Program Director

First name*

Last name*

Email address*

Location

Phone number*

Resume

Employees are required to meet certain conditions prior to being authorized to drive. Drivers must be at least 21 years of age, have a valid driver's license, have at least 3 years of driving experience, and have an acceptable driving history. I understand I must meet these conditions prior to being enrolled in the Driving for Danville curriculum.*

Do you have a high school diploma or equivalent?*

Danville confirms eligibility to work in the U.S. through E-Verify, an online government verification system. Are you authorized to work in the U.S.?*

Do you have case management expericence?*

Do you have leadership/supervisory experience?*

Please select the shifts that you are able and willing to work (Select all that apply).*

Status Desired (Select all that apply)*

What date could you start employment?*

How did you hear about this position?*

Have you worked at Danville Services before?*

Employment History

Please include contact information for three previous employers. Danville requires three favorable references to be considered for a role. Failure to provide sufficient information may cause delay or the disposition of application due to being incomplete.

Company Name:

Job Title:

Start Date:

End Date:

Supervisor's First and Last Name:

Company Phone Number:

Company City and State:

Position Description, Duties and Responsibilities:

Reason for Leaving:

Company Name:

Job Title:

Start Date:

End Date:

Supervisor's First and Last Name:

Company Phone Number:

Company City and State:

Position Description, Duties and Responsibilities:

Reason for Leaving:

Company Name:

Job Title:

Start Date:

End Date:

Supervisor's First and Last Name:

Company Phone Number:

Company City and State:

Position Description, Duties and Responsibilities:

Reason for Leaving:

Personal Reference

Please provide two personal references (Should not be a family member)

Full Name:

Relationship:

Phone Number:

Email:

Full Name:

Relationship:

Phone Number:

Email:

I acknowledge Danville as an At-Will Employer, meaning employment is for an unspecified duration and the employment relationship may be terminated at any time for any or no reason, with or without cause, and with or without notice by either party.*

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal.*

I acknowledge that pursuant to State and Federal regulations and guidelines, a thorough background check is required as part of this application process and may impact whether the applicant is hired. As a condition of continued employment, all employees are required to complete and pass a criminal background investigation which is initiated upon hire. **

My typed legal First and Last Name act as an electronic signature and authorizes Danville to investigate all information provided in the application and releases all parties from liability from any damage that may result from furnishing the same to Danville.*

Acknowledgements
Within seven days of hire, and at least every five years, all employees or those contracted with Danville are required to submit to fingerprinting to complete and pass a criminal background investigation. The following unresolved charges and convictions are considered disqualifying for employment at Danville Services of Nevada: If you have been convicted of, or have pending charges for, any of the following crimes:

Murder, voluntary manslaughter or mayhem;

Assault or battery with intent to kill or to commit sexual assault or mayhem;

Sexual assault, statutory sexual seduction, incest, lewdness or indecent exposure, or any other sexually related crime that is punished as a felony (including felony prostitution);

A crime involving domestic violence that is punished as a felony;

Abuse or neglect of a child or contributory delinquency;

Abuse, neglect, exploitation or isolation of older persons or vulnerable persons, including, without limitation, a violation of any provision of NRS 200.5091 to NRS 200.50995, inclusive, or a law of any other jurisdiction that prohibits the same or similar conduct;

A violation of any provision of NRS 422.450 to NRS 422.590, inclusive; or

Any other felony involving the use or threatened use of force or violence against the victim or the use of a firearm or other deadly weapon. If you have been convicted of, or have pending charges for, any of the following crimes within the immediately preceding 7 years:

Prostitution, solicitation, lewdness or indecent exposure, or any other sexually related crime that is punished as a misdemeanor;

A crime involving domestic violence that is punished as a misdemeanor;

A violation of any federal or state law regulating the possession, distribution, or use of any controlled substance or any dangerous drug as defined in chapter 454 of NRS;

I acknowledge that I have read and understand the above list of disqualifying charges and convictions.*

***Continuation

A violation of any provision of law relating to the State Plan for Medicaid or a law of any other jurisdiction that prohibits the same or similar conduct;

A criminal offense under the laws governing Medicaid or Medicare;

Any offense involving fraud, theft, embezzlement, burglary, robbery, fraudulent conversion or misappropriation of property; or

An attempt or conspiracy to commit any of the offenses listed above.

A record of conviction will not necessarily bar the applicant from employment and the appointing authority (employer) may consider factors such as: 1) the length of time that has passed since the offense; 2) the severity and nature of the offense; and 3) the relationship of the offense to the position for which the applicant has applied.

I acknowledge that I have read and understand the above list of disqualifying charges and convictions.*

Employee Application Supplemental Questions

Danville Services of Las Vegas LLC is a certified and/or approved contract provider of the Nevada Developmental Services (DS) Regional Center. The Nevada DS Regional Center requires that all applicants complete the following questions:

Have you ever worked with any agency which contracts with the State of Nevada Developmental Services Regional Centers (Desert, Rural, or Sierra Regional Center)?*

Have you ever worked for an agency, either within or outside, of the State of Nevada that serves a vulnerable population e.g., children, seniors or developmentally disabled?*

Have you ever had a professional license revoked and/or surrendered a professional license (nursing, etc)?*

If you answered "yes" to the previous question, what was the outcome? (Check all that apply)

If you answered "yes" to the previous question, please describe.

Have you ever been accused (placed on re-assignment/administrative leave) in an abuse, neglect, exploitation or mistreatment complaint and/or investigation?*

If so, were the accusations confirmed or substantiated?

If you answered "yes" to the previous question, what was the outcome? (Check all that apply)

If you answered "yes" to the previous question, please describe.

I declare that the information provided to the above questions is true and complete.

My typed legal First and Last Name act as an electronic signature*

Human Check*