Employment Application

Fill out the form below to apply for employment, fields marked with an asterisk (*) are required.

Personal Information

* First Name:

* Last Name:

* Address:

* City:

* State:

* Zip:

* Email Address:

* Phone Number:

Pre-Qualifying Questions

Do you have a high school diploma or equivalent?

Yes

Do you have an active/valid driver's license?

Yes

NYS law requires that a criminal background check be completed. Do you agree to be fingerprinted as part of the screening process?

Yes

This position may require you to transport consumers to medical appointments, etc. in your own car and provide your own transportation to meetings. Do you have the ability to do this?

Yes

Employment Information

* Position Applying for:

* Start Date:

* Desired Salary:

* Upload Cover Letter: (Microsoft Word or PDF files only, please.)

* Upload Resume: (Microsoft Word or PDF files only, please.)

* Verification: