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? |
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