Application Form

Work Experience

Name  
Address  
City   State   Zip  
Phone  
Personal experience with people with disabilities or someone with medical needs:
Work experience with people with disabilities or someone with medical needs:
 
 
 
Inquiry Yes No
Can you lift transfer someone in and out of a wheelchair?    
Do you smoke?    
Do you drink alcohol?    
Do you do drugs?    
Are you willing to fill out a background inquiry?    
Can you provide five references?    
Do you have reliable transportation?    
Do you have a good driving record?    
Do you have allergies to animals?    
Are you sensitive to cleaning chemicals?    

PAS User Manual Table of Contents
ILSC Home
| Bulletin Board | ILSC Services | Email ILSC