Please or Identify “am” “pm.” If available any time is acceptable. writing “any” If unavailable please in the box. mark “x” I am available and willing to work: Sun Mon Tues Wed Thurs Fri Sat Start Time: *Example: 9AM End Time: *Example: 10PM Overnight? Yes or No? How many hours per week would you prefer to work? ___________ Please note any exceptions or additional information regarding your availability: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Applicant Printed Name Applicant Signature Date Additional Information This information will be used to determine if we have clients available that suit your preferences. None of the following information will necessarily be disqualifying. In some instances training is provided, feel free to note like “Would DO NOT LEAVE BLANK training.” CDM provides services to Clark County. We have clients in all Vancouver areas. Camas; Washougal; Battleground; Yacolt; Amboy; Ridgefield; La Center and Woodland Where are you willing to work on a permanent basis? Where are you willing to work on a occasional basis?
Please Identify “am” or “pm.” If available any time writing “any” is acceptable. If unavailable please mark “x” in the box. I am available and willing to work: Sun Mon Tues Wed Thurs Fri Sat Start Time: *Example: 9AM End Time: *Example: 10PM Overnight? Yes or No? How many hours per week would you prefer to work? ___________ Please note any exceptions or additional information regarding your availability: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Applicant Printed Name Applicant Signature Date Additional Information This information will be used to determine if we have clients available that suit your preferences. None of the following information will necessarily be disqualifying. In some instances training is provided, feel free to note “Would like training.” DO NOT LEAVE BLANK CDM provides services to Clark County. We have clients in all Vancouver areas. Camas; Washougal; Battleground; Yacolt; Amboy; Ridgefield; La Center and Woodland Where are you willing to work on a permanent basis? Where are you willing to work on a occasional basis?
HCA-Application-January-2018.docx