Independent Contractor Application

Independent Contractor Application

Complete the following information to be considered for one of our contract positions with APAC. Required fields have an asterisk symbol ( * ) beside them, and must be completed before the application can be submitted. For questions, contact our APAC office at 866-803-2722.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Emergency Contact Name*

First NameLast Name
Emergency Contact's Phone Number*
Please enter a valid phone number.
Highest Level of Education Completed*

High School/GEDUndergraduate DegreePost Graduate Degree
Professional License Number
Current Employer (If not currently employed, enter N/A)*
Current Job Title (If not currently employed, enter N/A)
Do you currently work for DHR?*

YesNo
Are you an adoptive parent?*

YesNo
Enter any special courses or training received.
Share any previous adoption related experience.
Please select which contract position you are interested in*

Adult TherapistChild TherapistActivity Group LeaderParent Co-FacilitatorChildcare ProviderTIPS LeaderTIPS Parent Co-LeaderDeciding Together FacilitatorHome Study ProviderVolunteerOther
If you were referred for this contract opportunity, please enter the name of your refrence.
Please list the counties you are willing to work in*
Please upload a copy of your resume.

Cancelof
Reference #1 Name (3 references required)*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Place of Employment*
Relationship to Reference*
Reference #2 Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Place of Employment*
Relationship to Reference*
Reference #3 Name *

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Place of Employment*
Relationship to Reference*
Should be Empty: