Job Application for Contract Opportunity: Shared Living Provider (1099) at Aspire Living & Learning

Feel good about where you work and what you do!

Aspire Living & Learning, a non-profit human services agency, is seeking Shared Living Providers (1099 contractors) to open their homes and provide direct support to individuals with physical, medical, and developmental disabilities.

This is not an employment position with Aspire Living & Learning, but rather an opportunity for independent contractors. Shared Living Providers are responsible for the well-being and care of the individual in their home, and this is an application for a third-party contract position.

Great care and consideration is given to creating a therapeutic match between the individual and the Shared Living Provider, taking into account family style, philosophy, and other factors. Learn more about our Shared Living Provider arrangements by visiting our website: www.allinc.org.

Who We’re Looking for in a Contractor

A caring person, family, or couple with a flexible schedule who is ready to create opportunities for an individual to learn new skills and enjoy new experiences.
Holds a valid driver’s license, has reliable transportation, and is active in their community.
Has patience, acceptance, and understanding, and can provide structure, clear expectations, support with activities of daily living, and medication management.
Experience in supporting adults with developmental disabilities is preferred, but not required.
All applicable background checks for all household members.

Why become a Home Care Provider with Aspire Living & Learning?

Help someone maximize their potential by sharing your home and building meaningful relationships.
Receive a generous monthly tax-free stipend.

If you're interested in becoming a contractor with Aspire Living & Learning and want to positively impact lives while charting your own path, we would love to hear from you.

First Name

Last Name

Phone

Resume/CV*

Accepted file types: pdf, doc, docx, txt, rtf

Do you have a High School Diploma or GED?

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First Name

Last Name

Phone Number

Aspire Living & Learning is proud of the excellent and individualized services we provide to children and adults with disabilities. Our team members are committed to helping others live their best lives. What do you hope to add to the Aspire Living & Learning team?

Do you have any experience working with people with disabilities?

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If yes, please describe what you liked best about the experience-

Are you currently a home care provider for another agency?

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If yes, which agency?

Which of the following trainings/certification do you have (please check all that apply)?

First Aid

CPR

Restraint/Safety Care

Lifting and Transfer

Medication Administration

Sign Language

Computer Skills

Electronic Medical Records

ABA/Behavior Plans

Client Rights

Service Agreements/ISPs/IEPs

Would you have any problems working with verbally or physically aggressive individuals? Yes or No - If you answered YES please explain further-

Are you willing and able to assist and instruct in areas of personal care/hygiene? YES or NO- If you answered NO please explain further-

Are you willing and able to assist individuals in lifting and transfer, including a weight of up to 75 lbs? YES or NO. If NO, please explain further-

What city and state do you live in?

Street Address and zip code

Is your home handicap/wheelchair accessible?

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How many empty bedrooms do you have?

Where are the empty bedroom(s) located?

Are the empty bedrooms handicap/wheelchair accessible?

Do you have any pets? If so, what kind and how many?

Do you have HARD-WIRED, interconnected smoke detectors?

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Are you 18 years of age or older?

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Do you have any children living the home? If yes, How many and what are their ages?

How many people live in your home, and what are their ages?

Do you expect any changes to occur in your household. or lifestyle, within the next two years (for example: moving to another town, addition of a baby, family members moving in or out of the home)? If Yes, please explain further-

Do you have any reason to believe that you may be called away from home for a long period of time (for example, to care for a sick relative for a month)?

Do you have a valid driver's license?

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If contracted with us, do you have a reliable vehicle?

Do you have insurance coverage on your vehicle?

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Do you or any of your household members smoke? If yes, do they smoke inside or outside of the house?

Have you, or any member of your household, had any convictions or history of child abuse, neglect or mistreatment? If YES, please explain further-

Have you, or any other member of your household, ever been imprisoned, on probation, convicted and/or fined for any violation of any law? If YES, please explain further-

Has a complaint of client abuse or mistreatment ever been filed against you or any member of your household? If YES, please explain further-

Is there a restraining order against you or anyone in your household?

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Do you or anyone in your household have a history, or current problem with substance abuse?

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Are there any other present or past circumstances (for example, health problems, anger management issues, etc.) whose presence or recurrence would affect a person living in your home? If there is please explain further-

What prompted you to pursue becoming a residential provider for a person with disabilities?

What kinds of training, education, or personal experiences have you had that you feel would prepare you to live with a disabled individual?

Do you have a preference regarding the gender of the person you support? *

Male

Female

I do not have a preference regarding the gender of the person I support

Do you have a preference regarding the physical ability of the person you support? If YES, please explain-

How will it affect your family to have someone with special needs living with you?

Will you feel comfortable with this person in public places?

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What kind of behaviors might you find embarrassing?

In one word, how would you describe the relationship you would have with this person with special needs?

What is your favorite way to relax?

How do you and members of your household resolve conflict?

What do you consider to be your worst habit?

Do you cook? If yes, what type of food do you enjoy cooking?

What is your favorite thing to do that doesn't cost money?

What household chores do you like the best? Least?

Describe a typical week day evening in your home.

What are some things that stress you out the most on a daily basis?

Describe a typical weekend day in your home.

How do you express anger?

Do you mind others smoking cigarettes around you?

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What do you consider to be your best attribute?

Do you store firearms in your homes? YES or NO- If Yes- How are they stored?

Do you have any limitations (of any kind) that you feel we should know about?

Do you have any apprehensions about becoming a provider?

If offered a Home Care Providership, when are you available to start contracting with Aspire Living & Learning?

The following statement must be read and signed by you in order for Aspire Living & Learning to enter into a contract with you: I hereby certify that this disclosure form and the attached resume contain no false information and are completed to the best of my knowledge. I am aware that if an investigation reveals misrepresentation or falsification, Aspire Living & Learning may choose not to contract with me or to terminate such contract without notice. - Please Type Name-

Todays Date-

Reference- Please list 3 references- We will need their full name, Where you know them from, Phone # and email address.

Were you referred by a current employee? If so, please include their full name below.

Are you a current employee or contracted with Aspire Living & Learning?

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Contract Opportunity: Shared Living Provider (1099)

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