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 Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Highest Level of Education Completed
*
High School/GED
Undergraduate Degree
Post 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?
*
Yes
No
Are you an adoptive parent?
*
Yes
No
Enter any special courses or training received.
Share any previous adoption related experience.
Please select which contract position you are interested in
*
Adult Therapist
Child Therapist
Activity Group Leader
Parent Co-Facilitator
Childcare Provider
TIPS Leader
TIPS Parent Co-Leader
Deciding Together Facilitator
Home Study Provider
Volunteer
Other
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.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Reference #1 Name (3 references required)
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Place of Employment
*
Relationship to Reference
*
Reference #2 Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Place of Employment
*
Relationship to Reference
*
Reference #3 Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Place of Employment
*
Relationship to Reference
*
Submit
Should be Empty: