Application Form

SHS is firmly committed to a policy of affirmative action, equal employment opportunity and non-discrimination for all Providers and Receivers. All services are provided, referrals made and employment decisions taken without regard to race, color, national origin, creed, ancestry, sex, age, or handicap to ensure that each Provider and Receiver will be given equal treatment and opportunity with respect to terms and conditions of hiring, assignments, compensation and service delivery in order to match the best qualified applicant in every position and to deliver services to the Receiver based on their stated needs, interests and preferences.

Personal Information

Section 1 - General Information

(Numeric Answer Only)

Section 2 - Employment Verification

Section 3 - Education

Section 4 - Other Training/Pertinent Information

Section 5 - Current Employment

Section 6 - Employment History

Section 7 - Personal Reference 1

Section 8 - Personal Reference 2

Section 9 - Personal Reference 3

Section 10 - Emergency Contact Information

Section 11 - Services You Will Provide

Section 12 - Availability/Limitations

Section 13 - Verification/Signature

(Numeric Answer Only)

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.