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Legends Residential Care

Download, save, and fill out this form, then email to: info@legendsmaine.care

Application

Legends Employement Application

First Name

Middle Name

Last Name

Email

Date

Phone Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Job Applying for

DSP

House Manager

Salary Desired

Are you a Citizen of the United States

Yes

NO

If No are you authorized to work in the United States?

Yes

NO

Do you have a valid Driver's License?

Yes

NO

Have you worked for us before? If yes, when?

Yes

NO

Date

Have you ever been convicted of a felony?

Yes

NO

If yes, Please explain

Education

Please all the following questions.

Education: High School or GED

Education: College or University

Education Other:

Degree Obtained?

Yes

No

Trainings

Please select Which Trainings you have obtained.

Trainings Obtained

When are you Available to Start

Reference

Please fill out Professional References below:

First Reference Information

Second Reference Information

Third Reference Information

Employment History

Please enter Employment History Below:

Please add the name, address, phone number, email, business, relationship, etc. of a professional reference.

May we Contact the Employer

Yes

No

Availability:

What Shifts are you available to work?

Additional Notes:

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Legends Residential Care: Compassionate Support, Exceptional Care.

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1(207)-810-6610

324 Cummings Rd, South Portland, ME, 04106.

info@legendsmaine.care

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