Employment Application | Self-Direct, Inc.

Self-Direct Inc.

Application for Employment

Please Answer All Questions. Resumes Are Not A Substitute For A Completed Application.

We are an equal opportunity employer. Applicants are considered for positions without regard to race, religion, sex, national origin, age, disability, or any other category protected by applicable federal, state, or local laws.

THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE.

First Name:*

Last Name:*

Position Applied For:*

Home Phone Number:*

Cell Phone Number:*

Alternate Phone Number:*

Email Address:*

Emergency Contact Name:*

Relationship:*

Phone Number:*

City:*

State:*

Zip:*

Years you've lived there?*

City:

State:

Zip:

Years you've lived there?

Type of Employment Desired:*
Full-timePart-time

Date you can start if hired:*

Desired Salary/Hourly Rate:*

Are you willing to work overtime?*
YesNo

What transportation method do you use at this time?:*

We provide care 24 hours a day, 7 days a week. Please indicate your availability below.*

1st Shift2nd Shift3rd Shift

If there are any notes you have regarding your availability, please indicate them below.

Do you speak any other languages? If yes, please list them:

Have you previously applied for employment with Self-Direct Inc?
YesNo

If yes, when and where did you apply?

Have you ever been employed by Self-Direct Inc?
YesNo

If yes, provide dates of employment, location and reason for separation.