Join Our Team

Applicant Details

Name *

First

Last

Date of Birth *

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

What Position are Applying for?

DSP
SLP
Manager

Education

e.g. School Name Location Degree/Diploma Year Completed

Employment History

1. Organization/Company Name

Supervisor Name

Supervisor Phone Number

Reason for Leaving

Job title

Start Date

End Date

Responsibilities

2. Organization/Company Name

Supervisor Name

Supervisor Phone Number

Reason for Leaving

Job title

Start Date

End Date

1. Are you legally eligible to work in the U.S.?

Yes
No

2. Do you have a valid driver’s license?

Yes
No

3. Have you ever been convicted of a felony?

Yes
No

If yes, please explain

time Are Responsibilities

Professional Reference

Reference Name *

First

Last

Reference Email

Realtionship

Reference Phone

Reference Name *

First

Last

Reference Email

Relationship

Reference Phone

Reference Name *

First

Last

Reference Email

Relationship

CERTIFICATIONS & SKILLS

CPR/First Aid
Medication Administration Certification
Behavior Management Training
Crisis Prevention Training (CPI, MANDT, etc.)
Sign Language (ASL)
Experience with Intellectual & Developmental Disabilities

Other (please list)

Reference Phone

Availability

Which days are you available?

What time of day do you prefer?

Morning
Afternoon
Evening

Emergency Contact Information

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Emergency Contact Email

BACKGROUND CHECK & AUTHORIZATION

I understand that a background check, including criminal history and driving record, may be
required for employment. I certify that my answers are true and complete to the best of my
knowledge. I authorize Enhanced Life Services to verify all information provided.
I also understand that employment with Enhanced Life Services is at-will, meaning either party
may terminate the employment relationship at any time with or without cause or notice..

Signature

Date / Time

Date

Time

Applicant Details

Employment History

Professional Reference

Availability

Emergency Contact Information

BACKGROUND CHECK & AUTHORIZATION

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