DSP Application | Sulandra Community Living Services

Basic Information

Step 1

First name

Please enter your first name.

Last name

Please enter your last name.

Date of birth

Please enter your date of birth.

Marital status

Please select a marital status.

Email

Please enter a valid email.

Phone

Please enter a valid phone number.

Address

Please enter your address.

Apt / Unit

City

Please enter your city.

State

Please select your state.

ZIP

Please enter a valid ZIP code.

Preferred contact method

Emergency Contact

Step 2

Required.

Emergency contact name

Please enter an emergency contact name.

Relationship

Please enter relationship.

Emergency contact phone

Please enter a valid phone number.

Alternate phone (optional)

Availability & Preferences

Step 3

Earliest start date

Please select a start date.

Employment type

Please select an employment type.

Preferred shift

Please select a shift preference.

Desired hours per week

Days available

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Please select at least one day.

Max travel distance

Reliable transportation?

Experience & Education

Step 4

Caregiving / DSP experience

Please select experience.

Highest education

Please select education.

Why do you want to be a DSP?

Driver’s License

Step 5

Driver’s license number

Please enter your driver’s license number.

Driver’s license expiration date

Please enter license expiration date.

Issuing state

Please select issuing state.

Do you have a valid driver’s license?

Please select an option.

Eligibility & Screening

Step 6

Are you at least 18 years old?

Please answer this question.

Work authorization (U.S.)

Please select an option.

Can you pass a background check and drug screening?

Yes, I consent to screening.

No.

Please select an option.

Certifications

Step 7

Select all that apply. If you select a certification, the issue date and expiration date are required.

Please select at least one option (or select “No current certifications”).

No current certifications

CPR

CPR issue date

Issue date required.

CPR expiration date

Expiration date required.

Issuing organization (optional)

First Aid

First Aid issue date

Issue date required.

First Aid expiration date

Expiration date required.

Issuing organization (optional)

Medication Administration

Issue date

Issue date required.

Expiration date

Expiration date required.

Issuing organization (optional)

CPI / De-escalation

Issue date

Issue date required.

Expiration date

Expiration date required.

Issuing organization (optional)

Other certification

Certification name

Certification name required.

Issue date

Issue date required.

Expiration date

Expiration date required.

Issuing organization (optional)

Resume & Optional Documents

Step 8

Resume (PDF, DOC, DOCX)

Click to choose resume… No file

Max 10MB. Required.

Please upload your resume (10MB or less).

Cover letter (optional)

Click to choose cover letter… Optional

Max 10MB.

Cover letter must be 10MB or less.

CNA document (optional)

Click to choose CNA document… Optional

Max 10MB.

CNA document must be 10MB or less.

STNA document (optional)

Click to choose STNA document… Optional

Max 10MB.

STNA document must be 10MB or less.

Files (selected / submitted)

No files selected yet.

After submit, this list will show the actual uploaded files with clickable links.

Work History

Step 9

Most recent job.

Last employer

Please enter your last employer.

Job title

Please enter your job title.

Start date

Please enter start date.

End date

Please enter end date.

Reason for leaving

Please provide a reason for leaving.

Supervisor/HR phone (optional)

Consent to contact previous employer?

Please select an option.

Professional References

Step 10

Provide at least two professional references. You may add more.

Please provide at least 2 complete references.

I consent to contact my references.

Consent to contact references is required.

DSP Knowledge Assessment

Step 11

Answer all 15 questions. Your answers will be submitted with your application.

Please answer all assessment questions.

1) What is the best first step when you notice an individual is becoming upset?

A. Tell them to stop immediately

B. Speak calmly, give space, and assess what they need

C. Leave without notifying anyone

D. Post about it on social media for advice

2) Which choice best protects confidentiality?

A. Discussing client details in a public hallway

B. Sharing information only with authorized staff who need it for care

C. Sharing details with friends if names are not used

D. Leaving paperwork visible on a counter

3) If you suspect abuse, the correct action is to:

A. Wait to see if it happens again

B. Report immediately following agency/state policy

C. Confront the suspected person privately and keep it secret

D. Ignore it unless you have proof

4) Person-centered support means:

A. Staff decide what is best without input

B. Supporting the individual’s goals, preferences, and choices

C. Doing everything for the individual to save time

D. Only focusing on medical tasks

5) When documenting care, you should write:

A. Opinions and guesses

B. Objective, factual observations and actions taken

C. Only what went wrong

D. Nothing if the shift was quiet

6) Select all tasks that are typically considered ADLs (Activities of Daily Living).

Bathing

Dressing

Shopping for groceries

Toileting

Eating/feeding

7) Select all ways to reduce the spread of infection.

Handwashing

Using gloves appropriately

Sharing personal cups/utensils

Cleaning/disinfecting high-touch surfaces

Covering coughs/sneezes

8) Select all examples of respectful communication.

Asking preferences and listening

Talking over the person to others

Using clear, calm, respectful language

Protecting privacy during personal care

Using a nickname they did not choose

9) Select all situations that should be reported immediately to a supervisor.

Injury or fall

Medication error

Suspected abuse/neglect

Running 5 minutes late for a routine outing (no risk)

Individual is missing/unaccounted for

10) Select all items that belong in objective documentation.

Times and specific actions taken

Direct quotes when relevant

Labels like “lazy” or “bad attitude”

What you saw/heard (observable facts)

Assumptions about motives

11) Scenario: A client refuses to take a shower and starts yelling when you bring it up. What do you do next?

Tip: Explain what you would say/do first, and what you would do if it escalates.

12) Scenario: You notice a client has a new bruise. They seem nervous and say “I’m fine” and won’t explain. What do you do?

Tip: Focus on safety, reporting, confidentiality, and objective documentation.

13) Scenario: A client wants to go to the store alone, but their care plan notes poor safety awareness. How do you support choice while managing risk?

Tip: Include alternatives, skill-building, supervision options, and plan-following.

14) Scenario: You are running behind and a client’s medication time is approaching. What do you do to stay safe and compliant?

Tip: Think: safety first, policy, documentation, notifying supervisor/coverage.

15) Scenario: Another staff member speaks disrespectfully to a client in front of others. What do you do?

Tip: Include dignity/respect, immediate client support, reporting, and professionalism.

Scoring: The application will include your answers and an automatically computed score for objective questions. Final review may include manual scoring if needed.

Final Consents

Step 12

I certify that all information provided is true and accurate.

You must certify before submitting.

I consent to be contacted about my application.

Consent is required.

I understand punctuality is essential and I can commute to work on time as scheduled.

This acknowledgement is required.

I agree that typing my name below serves as my electronic signature.

E-sign consent is required.

Electronic signature (type full name)

Please type your full name as signature.

Signature date

Please select a date.

Autosave: off

Submitting… Please don’t close this tab.

Application for: Direct Support Professional (DSP)

Basic Information

Emergency Contact

Availability & Preferences

Experience & Education

Driver’s License

Eligibility & Screening

Certifications

Resume & Optional Documents

Files (selected / submitted)

Work History

Professional References

DSP Knowledge Assessment

1) What is the best first step when you notice an individual is becoming upset?

2) Which choice best protects confidentiality?

3) If you suspect abuse, the correct action is to:

4) Person-centered support means:

5) When documenting care, you should write:

6) Select all tasks that are typically considered ADLs (Activities of Daily Living).

7) Select all ways to reduce the spread of infection.

8) Select all examples of respectful communication.

9) Select all situations that should be reported immediately to a supervisor.

10) Select all items that belong in objective documentation.

11) Scenario: A client refuses to take a shower and starts yelling when you bring it up. What do you do next?

12) Scenario: You notice a client has a new bruise. They seem nervous and say “I’m fine” and won’t explain. What do you do?

13) Scenario: A client wants to go to the store alone, but their care plan notes poor safety awareness. How do you support choice while managing risk?

14) Scenario: You are running behind and a client’s medication time is approaching. What do you do to stay safe and compliant?

15) Scenario: Another staff member speaks disrespectfully to a client in front of others. What do you do?

Final Consents