LIFE - Employment Application

Please fill out and submit the following information. We will contact you if we have any openings that might match your skills and interests.

	Name:
	Email Address:
	Street Address:
	City:
	State:
	Zip:
	Daytime Phone:
	Evening Phone:
	What type of position are you interested in?
	If hired, what hours are you avaialable to work?
	What can you offer to the indiviuals we serve?
	Do you have experience working with the developmentally disabled?		Yes No
	Is there anything else that you would like to tell us?