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Want to join our team? We would love to have you! Please fill out the form below. Thank you for your time!

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Name

First

Last

Phone Number

Are you authorized to work in the United states?

Are you 18 years of age or older?

Do you have a high school diploma or GED?

Do you have a valid Drivers license?

Do you currently reside in Washington State?

How long have you resided at your current address?

Number of years

How long have you resided in Washington state?

Number of years

Do you have a reliable vehicle?

Do you have proof of insurance for your vehicle?

The State of Washington has regulations that require a criminal, employment, and personal background/fingerprint checks on all new employees.

Please list any Training, Certifications you have documentation for?

Please describe your experience, if any, working with Adults and/or Children for care, special needs, or disabilities:

Are you comfortable with personal care? Such as bathing, cleaning, assisting clients?

Are you looking for Full-time, or Part-time work?

Full-Time
Part-Time

What days and times of the week are you available to work?

What days and times, if any, are you unable to work?

Please list 2 professional references with phone numbers:

lease list 2 personal references, with phone numbers:

Were you recommended to us by someone? If so, please list that person’s name:

I hereby declare that the details provided above are true and correct to the best of my knowledge and I understand it is my responsibility to inform Grace Support Services of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it. I hereby authorize sharing of the information with Grace Support Services solely for the purpose of obtaining employment, which will include a background check as required by the State of Washington.

ENTER FULL NAME TO AGREE