* Required field.

• Name*
• Street Address *
• Address (cont'd):
• City*
• State*
• Zip*
• Home Phone*
• Cell Phone*
• Email Address*
• Today's Date*
• Are you eligible to work in the USA?
  yes No
• Do you have a valid Minnesota driver's license?
  yes No
• Will you consent to a pre-employment background and driving record check?
  yes No
• Do you have reliable transportation and are you willing to travel within the Twin Cities metro area?
  yes No
• Are you able to lift up to 50lbs?
  yes No
• Do you have previous experience working with individuals with Development Disabilities?
  yes No
• If yes, for approximately how many years?
• Do you have previous experience working with individuals with Severe and Persistent Mental Illness?
  yes No
• If yes, for approximately how many years?
• Do you have one of the following degrees?
  Bachelor of Science or Arts in Human Services or related field Associate of Science in Human Services No
• Are you currently employed?
  yes No
• When are you available to work? (Check all that apply.)
  Days (7am-3pm) Evenings (3pm-10pm) Awake Overnights (10pm-8am) Weekends
• Date you can begin employment?
• Number of hours a week you are available to work?
• Are you currently certified in:
  CPR First Aid
• Have you received training in Medication Administration and able to provide documentation?
  Yes No
• How did you hear about us?
• If an employee or associate of this company referred you to us, please provide their name:
• Please give us a brief description of your experiences.
• Describe education, training, certifications, employment and volunteer work. Also list reasons why you want to work as a temp for Social Service Solutions.
• Attach resume

By submitting this brief application you declare that all of the information is true. Social Service Solutions will verify all the information that you provide to us in the application process. Candidates / employees who provide false information may be subject to discharge.