Who We Are

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Employment Application Form
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Educational Background (circle highest grade completed)
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Name
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Name

Employment History (Please start with your current employer and work back)





Please give the name, addresses, and telephone numbers of three references, professional or personal (not related to you) whom we may contact if the above cannot be reached:

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Scenario Questions

You are getting a resident ready for Day Program on a cold, snowy day. As the van pulls up he is refusing to put on a jacket. How would you handle this situation?

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A client comes to you and tells you that they have a secret. This client takes several medications on a daily basis. They proceed to tell you that on a recent home visit they went out with their older brother and consumed alcohol. The client tells you that they consumed enough to become intoxicated. How would you proceed?

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I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

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