Employment Application
Fill the form below accurately indicating your potentials and suitability to job applying for.
Name
*
First Name
Last Name
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
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
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Phone Number
*
Format: (000) 000-0000.
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How were you referred to us?
*
Walk-In
Referral
Newspaper Ad
Facebook
Twitter
LinkedIn
Other (please specify)
Describe your experience supporting people with intellectual or developmental disabilities (IDD), autism, or acquired brain injuries (ABI).
Please Select
0-1 Year
1-2 Years
3 or more Years
None
Are you willing to drive individuals to appointments, activities, and other community destinations as part of your job duties?
Yes
No
Have you ever been convicted of a misdemeanor or felony? Do not include arrests that did not result in a conviction, juvenile adjudications, or expunged convictions.
Yes
No
Resume and Cover Letter
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Motivation letter
*
Training and Certifications
References
Please list two (2) references that are familiar with your work life.
Reference
Reference
Driver’s License
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Social Security Card
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Passport
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Car Insurance
Browse Files
Drag and drop files here
Choose a file
Cancel
of
CPR/First Aid Certification
Browse Files
Drag and drop files here
Choose a file
Cancel
of
TB Screening
Browse Files
Drag and drop files here
Choose a file
Cancel
of
I authorize Vanguard Supports of Louisville, LLC to request and review the following checks for employment screening: Kentucky Administrative Office of the Courts criminal record report, Kentucky Child Abuse and Neglect Central Registry check, Kentucky Vulnerable Adult Maltreatment Registry check, Kentucky Nurse Aide Abuse Registry check. I authorize the release of the results to Vanguard Supports of Louisville, LLC for employment screening. I agree to complete any additional authorization forms required by the agencies conducting these checks.
Yes
No
Signature
Date
Submit Application
Submit Application
Should be Empty: