Welcome to Smiles Like Yours Adult Support Services! To ensure a smooth application process, please fill out all sections of the application completely and accurately.

First Name *

Last Name *

Date of birth

Phone *

Email *

Home Address *

City *

State *

Zipcode

How many years of service do you have working with individuals with Intellectual disabilities? *

Select

Less then 1 year
1 - 2 years
3 - 5 years
5+ years
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Which position would you like to be considered for? *

Direct Support Professional

Adult Social Club Supervisor

Residential Coordinator

Residential Program Manager

Social Club Program Manager

Program Director

Are you CPR and First Aid Certified? *

Yes

No

Are you willing to undergo a background and central registry check? *

Yes

No

Do you have a positive driving record? *

Yes

No

Education History

Highest level of education obtained

Select

GED
Highschool Diploma
Bachelors Degree
Masters Degree
Doctorate Degree
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Institution Name

Field of Study

Please provide three references

Reference 1.

Reference Name: *

Relationship to Reference *

Phone Number *

Email Address *

Reference 2.

Reference Name: *

Relationship to Reference *

Phone Number *

Email Address *

Reference 3.

Reference Name: *

Relationship to Reference *

Phone Number *

Email Address *

Anything else you would like for us to know?

Please upload your resume

Resume

Choose file(s) to upload

Supervisor Name

Employee rated

Supervisor titlte