Skip to content
Home
Residential Services
Day Services
Community Services
Respite Services
Join Our Team
About Us
Contact Us
Enhanced Life Services
Home
Residential Services
Day Services
Community Services
Respite Services
Join Our Team
About Us
Contact Us
Join Our Team
Available Position
DSP
SLP
Manager
APPLICATION FOR EMPLOYMENT
We consider applicants for all positions without regard to race, religion, creed, color, gender, national origin, citizenship status, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.
Name
*
First
Middle
Last
Full Address
Email Address
Phone Number
Day Of Birth
*
Are you 18 years of age or older?
Yes
No
What Position are Applying for?
SLP
DSP
Manager
Other
If other please Specify
HOW DID YOU HEAR ABOUT US
Walk-in
Advertisement
Friend
Employment Agency
Relative
Other
If other please Specify
Have you ever filled an application with us before?
Yes
No
If yes, please indicate date:
Are you currently employed?
Yes
No
May we contact your present employer?
Yes
No
Are you prevented from lawfully becoming employed in this Country because of Visa of Immmigration Status? Proof of citizenship or immigration status will be required upon employment
Yes
No
On what date would you be able to start work?
Your work availability:
Full Time
Part Time
Shift Work
Temporary
Days
Evenings
Nights
Weekends
Are you currently on "lay-off" status and subject to recall?
Yes
No
Can you travel if a job requires it?
Yes
No
Have you been convicted of a felony in any jurisdiction?
Yes
No
If yes, please explain:
EDUCATION
High School Name, Address, Course of Study, Years Completed Diploma Degree
Undergraduate College Name, Address, Course of Study, Years Completed Diploma Degree
Graduate College, Address, Course of Study, Years Completed Diploma Degree
Other(Specify)
If you would like to be considered for a position which requires proficiency in another language, please indicate by checking the box and indicating the language(s) in which you are fluent.
Yes
No
Specify
SPECIALIZED SKILLS & QUALIFICATIONS:
Describe any specialized training, apprenticeships, skills, or experience with special population:
Describe any job-related training received in the United States military:
WORK HISTORY
Employer (1)
Address
Work Phone
Job Title
Start Date
End Date
Reason For leaving
Employer (2)
Address
Work Phone
Job Title
Start Date
End Date
Reason For leaving
Employer (3)
Address
Work Phone
Job Title
Start Date
End Date
Reason For leaving
REFERENCES
Reference1-Name
Address
Phone Number
Reference2-Name
Address
Phone Number
Reference3-Name
Address
Phone Number
APPLICANT'S STATEMENT I certify that the answers given herein are true and complete to the best of my knowledge. I authorize the release any information regarding my employment. I also authorize to check my background for any criminal record. This application for employment shall be considered active for a period of time not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of at will employment in certain jurisdictions and that relationship may or may not be changed by any written document or by conduct unless such change is specifically acknowledge in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate discharge from employment from our organization. I understand that I am required to abide by all rules and regulation set forth by the employer.
Sign Your Name
Date
