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 PRE APPLICATION

Full Name*

Address *

Email Address*

Phone*

How did you hear about us?

Do you have experience in using a Hoyer Lift?*

Do you have a High School Diploma/GED/Transcript?*

Do you have a Current Driver License?*

Current CPR/FIRST AID card?*

Are you willing to travel*

Are you an STNA*

Do you have a vehicle *

How many years of experience*

Are you willing to work weekends*

Are you a Certified Med Passer*

Do you have reliable Transportation*

Are you willing to work full time or part time?*

Have you ever cared for a individual that have intellectual Disabilities?*

Have you ever cared for a individual that have Sensory Disabilities?*

Have you ever cared for a individual that have Mental Disabilities like *

Have you ever cared for a individual that have Physical Disabities? If so please explain.*

Can you pass a Background? If no please explain.*

How soon can you start?*

What is your desire Pay Rate if hired?*

If we only have part time hours, are you willing to take it?*

Any Question?

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