Welcome to the Living Innovations Career Center

Employment Inquiry

Note: A pre-employment background check and motor vehicle record check is required by Living Innovations prior to employment.

If you prefer, you can download this form as a pdf and fax it to us at (603) 772-5690. You will need Adobe Acrobat Reader to view the pdf, download a free copy here.

Application Date *	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008
First Name: *
Last Name: *
Current Address:
City: *
State: *	Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip: *
Phone: *
Email Address: *
Position Applied For:
How did you hear about us?:
Have you ever applied with us before?: *	Yes No
Are you legally authorized to work in the US?: *	Yes No
Have you ever been convicted of a crime?: *	Yes No
If yes, please explain:
Have you worked a similar position before?: *	Yes No
Where?:
What mileage radius are you willing to travel from home for work?:	Less than 25 miles 26-50 miles 51-75 miles More than 75 miles
Work Availability: *	Full-time Part-time
How many hours would you like to work per week?:
What days are you available to work?: *	Monday Tuesday Wednesday Thursday Friday Saturday Sunday
What hours are you available to work?: *
Do you have previous experience working with people with disabilities?: *	Yes No
Do you have previous experience working with the elderly population?: *	Yes No
Please describe your experience working with the elderly or people with disabilities:
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