Job application PERSONAL INFORMATION Name * Name First Name First Name Middle Name Middle Name Last Name Last Name Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Date of Birth * Email * Phone Number * EMPLOYMENT AND EDUCATION Are you currently employed * YES NO List Previous Place(s) of Employment(Most recent) * Which positions are you interested in * Weekends Direct Support Professional (3pm-11pm) Direct Support Professional(8am -4pm) Weekdays Overnights Other Other preferred positions When are you available to start * Level of Education * High School / GED College degree Graduate School Other Other qualifications QUALIFICATIONS AND LICENSE Select all that apply * FIRST AID AND CPR DDA TRAININGS CMT MANDT BACKGROUNDS AND CHECKS Do you consent and authorize LCSS to conduct a background check? * Yes No Have you been convicted of a crime in the last 7 years * Yes No Have you been convicted a felony * Yes No Explain in detail any questions answered "YES" under the background checks(Criminal or Felony) Do you have a vehicle * Yes No Do you have a valid driver's license * Yes No Are you a US citizen or authorized to work * Yes No File Upload * Drop a file here or click to upload Choose File Maximum file size: 268.44MB How did you hear about Us * Privacy policy * I allow this website to collect and store the submitted data Submit If you are human, leave this field blank.
