Application Form Personal InformationFirst Name(Required) Last Name(Required) What Position are you applying For??(Required)Group Home House ManagerCoporate Office positionBus Aide split ShiftDTA DirectorDTA DriverGroup home weekend Sat and Sun 8a-8mGH Overnights Mon- Thurs 11p-8aGroup Home afternoon 3p-11pGroup Home weekend Overnights Fri- SunDTA Direct care Mon- Fri 8a-4pDTT Mon-Fri 11a-7pmHR SpecialistTrainerGroup home DirectorCare coordinatorWhich Program?Day Treatment Program(DTA)Residential Habilitation(Group home)Email Address(Required) Phone(Required)Address(Required) Street Address Social Secuirty Number(Required)Please Check All That Apply Are you at least 18 years of age? Do you have a valid Drivers License? Available Start Date(Required) MM slash DD slash YYYY Emergency Contact InformationEmergency Contact Name(Required) Phone(Required)Address(Required) Street Address Education and TrainingDo you have a high school Diploma or College Degree?(Required) How many years of school did you complete?Please Check All That Apply Do you have your fingerprint clearance card? Legal HistoryPlease Check All That Apply(Required) I have Never been convicted of a felony. I'm legally authorized to work in The United States I have NO pending criminal charges. I'm able to lift 30 - 50 lbs. I have never been investigated by the Department of Child Safety or Adult Protective Services. Explain Your Answers if NecessaryEmployment Experience Current or Most Recent EmploymentCompany Name Address Street Address Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Supervisor Name Phone NumberPay Rate Job Title and Duties Reason for Leaving If Currently Still Employed, May We Contact As A Reference? Yes No Please Provide Four References. (References Cannot Be Family)Reference OneName(Required) Phone(Required)Relationship(Required) Years Known(Required) Reference TwoName(Required) Phone(Required)Relationship(Required) Years Known(Required) Reference ThreeName(Required) Phone(Required)Relationship(Required) Years Known(Required) Reference FourName(Required) Phone(Required)Relationship(Required) Years Known(Required) How Did You Hear About Us? Social Media Family/friend Google Search Third Party Website University School Job Fair What Website? Who Referred You? Resumes Are Not a Substitution. In Addition, You May Submit Your Resume. Drop files here or Select files Max. file size: 100 MB. Resume and/or Cover Letter CommentsThis field is for validation purposes and should be left unchanged.
