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Standard Care delivers exceptional services that transform the lives of the individuals in our care. We hire dedicated, responsible individuals who share our values and are committed to making a difference.

EEO Statement: Standard Care is an equal opportunity employer and does not discriminate on the basis of age, race, color, religion, national origin, sex, ancestry, genetic information, retaliation, gender identity, sexual orientation, disability, pregnancy, military service, marital status, whistleblower, worker’s compensation, or physical or mental employment discrimination. For any questions, contact us at [email protected] or (405) 476-0594

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- Step 1 of 5

Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email Address *

Phone Number *

The position you are applying for *

On what date can you begin? *

Are you available to work *

Full-time
Part-time
Temporary

Are you at least 18 years of age? *

Yes
No

Can you travel for work if needed? (copy) *

Yes
No

Do you have a valid driver’s licence ?

Yes
No

If Yes , From which state

Has your driver’s license ever been revoked?

Yes
No

Please check which days and shifts you are available to work

Layout

Monday

Wednesday

Friday

Sunday

Tuesday

Thursday

Saturday

Emergency Contact

Layout

Name

Relationship

Telephone

Do you know of any reason you cannot perform the essential functions of the job for which you are applying with or without reasonable accommodation?

Yes
No

Have you ever gone by a name other than the one listed above?

Yes
No

If yes, please list here

Have you ever been convicted of a crime?

Yes
No

If yes, please explain and include dates

Have you ever had a substantiated case brought against you by child and/or adult protective services?

Yes
No

If yes, please explain and include dates

SKILS & QUALIFICATIONS

Please list all licenses and certifications you now hold

DSP
CRMA
CPR / FIRST AID
CPI
LCSW
LCPC
MSW
LADC
CAN
LPN
RN
MHRT
Other

Education History

HIGH SCHOOL

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School Name and Location

Years completed

Course of study

Degree or Diploma?

College

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School Name and Location

Years completed

Course of study

Degree or Diploma?

Graduate

Layout

School Name and Location

Years completed

Course of study

Degree or Diploma?

Business/Trade Technical

Layout

School Name and Location

Years completed

Course of study

Degree or Diploma?

WORK EXPERIENCE

Provide complete information for your past 2 employers. Start with your present or most recent job.

Employer I

Company,Agency Name *

Telephone

Address

Employment dates

Layout

From *

To *

Job Title *

Suprvisor

Reason for Leaving *

May we contact this employer?

Yes
No

If no, please explain why

Employer II

Company,Agency Name *

Telephone

Address

Employment dates

Layout

From *

To *

Job Title *

Suprvisor

Reason for Leaving

May we contact this employer?

Yes
No

If no, please explain why

Employer III

Company,Agency Name *

Telephone

Address

Employment dates

Layout

From *

To *

Job Title *

Suprvisor

Reason for Leaving

May we contact this employer?

Yes
No

If no, please explain why

Military history

Did you serve in the US Armed Forces?

Yes
No

If yes, in which branch? Describe any military training you received that you believe would be pertinent to the position for which you are applying.

REFERENCES

Reference I

Name *

First

Last

Telephone *

Reference II

Name *

First

Last

Telephone *

Reference III

Name *

First

Last

Telephone *

ADDITIONAL INFORMATION

I am authorized to work in the United States:

Yes
No

SIGNATURE

Acknowledgment and Sending the application *

I certify that the information contained in this application is true and complete.
I authorize investigation of all statements contained in this application for employment as may be necessary for arriving at an employment decision.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.

Single Line Text

Name *

First

Last

Name *

First

Last

About Us

At Standard Care, integrity is the foundation upon which we build our business. We firmly believe that honesty, transparency, and ethical conduct are essential in all our interactions.

Our Values

Excellence
Integrity
Dignity

Contact Us

190 Riverside St, Portland ME 04103
(207) 939-8240
[email protected]

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