Relief Resources

	Children Services Staffing Support
	Human Services & Behavioral Health
	Social Change Staffing Support

	Bulletin Board
	Events Training
	Contact Info

Human Services Field Staff Application

Thanks for your interest in working with us. There are two ways for you to apply using this form.

Part 1	If you just want to let us know you're interested and we should contact you, simply fill out the top section and click submit at the bottom of this screen.
Part 2 & 3	If you prefer to provide us with additional information about your background, experience, availability, etc, just finish filling in the additional areas. By providing this additional information we can guide your application through our process more effectively (and a little bit quicker too!)
Part 1 Contact Information
Name
Address:
City:
State:
Zip Code:
Email
Home Phone
Alt. Phone
Beeper
How did you hear about Relief Resources:
Have you ever applied/interviewed/worked at RR before? No Yes If yes, when?
Best time and way to reach you:
Additional Comments



Part 2 Experience
What age groups have you worked with?
	Children	Adolescents
	Adults	Elders
What Populations have you worked with?
	Mental Health	Mental Retardation	At Risk Youth
	Physically Challenged	Autistic	Head Injured
	Homeless	Substance Abuse
	Other
What settings have you worked in?
	Residential	Educational	Vocational
	Day Care	Shelters	Family Respite
	Crisis Intervention	Rehabilitation
	Other
How many years of experience do you have?
	6mos.-1 year	1-2years	2-3years
	4-5years	5-10years	over 10 years
What is your educational background?
	HS Diploma	Undergrad	Associates
	BA/BS	Master level	PHD
What Trainings Certificates do you currently hold?
	CPR/First Aid	Restraint	Med. Admin.
	OFC Certified	Lead Teacher
	Other

Part 3 Preferences & Availability
Which geographic area would you like to work in?
	Greater Boston	North Shore	South Shore
	Metro West	Greater Worcester	Southeastern Mass
	Western Massachusetts	Rhode Island	Connecticut
	Other
What Field(s) are you interested in working?
	Mental Health	Mental Retardation	At Risk Youth
	Physically Challenged	Criminal Justice	Autism
	Head Injury	Homeless	Substance Abuse
	Other
What type of position are you looking for?
	Direct Care	Respite	Educational
	Vocational	Clinical/Case Mgt	Managerial/ Supervisory
What type of hours are you looking for?
	Day	Evening	Overnights
	Weekdays	Weekends
How many hours per week would you like to work?
	0-10	10-20	20-30
	30-40	Over 40
When would you be available to start working?
	Immediately	2-4 weeks
	4-6 weeks	Other
What type of transportation do you utilize?
	Car	Public
	Bicycle	Other

	BACK TO TOP
62 Main Street PO Box 129 Hatfield, MA 01038-0129 Offices in Massachusetts, Rhode Island and Connecticut


800-639-5094	413-247-3114
Fax:413-247-3837	email:info@reliefresources.com