APPLY TO LLM TODAY JOIN OUR TEAM Position Applied For: * Residential Direct Support Professionals Community Supports Direct Support Professional Day Training Direct Support Professional Leadership Team Name * First Name Last Name Email * Phone * (###) ### #### All States & Counties Lived in within last 12 Months * Please list all states (and counties in states) that you have been a resident of or worked in within the last 12 months. Example: Kentucky, Jessamine Are you legally eligible for employment in the United States? * Yes No Check all for which you are willing to work: * Full Time Part Time 16 hour Shifts Weekends Volunteer On what date would you be available to work? * MM DD YYYY Additional comments regarding schedule/availability: Do you have a valid driver’s license? * Yes No Do you have an operative vehicle with insurance? * Yes No What is your primary form of transportation? Have you ever been convicted of a crime? * Yes No If so, when, where and what was the disposition of the case? You must be able to lift, transfer, or position participants who are unable to do so independently. By typing your initials on this line you are stating that you meet this requirement: * Thank you!
