Application for Employment Questionnaire

Name *
Name
Cell Phone
Cell Phone
Do you have a high school diploma or equivalent? *
Do you have legal authorization to work in the United States? *
Do you have a valid driver’s license? *
Do you have your own personal transportation? *
Can you provide documentation of current auto insurance coverage? *
Our in-home therapy positions require the ability to bend, sit on low surfaces (such as a child-sized chair and the floor), engage in outdoor and gross/fine motor play, and lift the child as needed (weight could range from 30-60 pounds). Can you perform these essential job functions? *