Postion Applying For
Primary Phone Number
Secondary Phone Number
Email Address (Required)
18 years or older?
Have you previously applied at Full Life?
Do you have a valid driver's license?
Do you have reliable transportation?
If yes, when?
Employment History: Starting with present or most recent, list your last 3 previous employers. Include self-employment, military service, summer, and part-time jobs.
Most recent or current employer
Dates employed (from - to)
Wage or salary per hour
Reason for Leaving?
References (not relatives and at least 2 business references)
City or Town
City or town
Name of High School
City and State
Did you graduate?
Name of Institution
Course of Study
Degree or Certificate Earned:
One year experience working with people with disabilities?
First Aid Certificate?
Positive Behavioral Supports Training?
Certified Direct Support Worker or Caregiver?
Skills and Certificates
Please describe other job related training, scholastic honors, and vocational and/or professional information:
What type of position are you looking for?
When are you available?
How many hours a week?
Please explain your availability if we need more information:
Are you willing to provide personal assistance to individuals such as:
1. Helping individuals who are unable to toilet themselves
2. Changing Attends and cleaning after toileting accident
3. Helping individuals who are unable to bathe themselves
4. Helping individuals who are unable to feed themselves
Are you willing to assist individuals that have behavioral challenges if:
5. There is a possibility that an individual may hit or kick you?
6. If there is the possibility that someone may bite you?
7. If the individual you are assisting exhibits inappropriate sexual behavior?
8. If someone yells or uses profanity?
Are you willing (and able) to assist individuals who have physical challenges by:
9. Lifting and/or assisting individuals that are non ambulatory
10. Learn to use mechanical devices to assist individual
Are you willing to help individuals be a part of their community and to:
11. Accompany individuals to community activities and events
12. Assist individuals in utilizing public transportation
13. Use your personal automobile to transport our clients?
Are you willing and able to be a part of the team and agree that you will:
14. Be dependable and show up for work on time as scheduled
16. Work occasionally for others when they are unable to work
17. Work some holidays
18. Participate in required training within the specified time lines
Do you currently know anyone working for Full Life?
If yes, who?
Full Life is an equal opportunity employer. Full Life will not discriminate on the basis of race, color, gender, gender orientation, national origin, veteran status or disability. Equal access to programs, services, and employment is available to all persons. Those applicants requiring reasonable accommodation to the application process and/or interview process should notify the Human Resources Assistant at 322-9333.
There are terms and conditions to employment at Full Life that will be covered if you are offered a position. You should know that by clicking on the submit button at the bottom of this page, you acknowledge that any misrepresentation on this application may be justification for refusal to interview or termination from employment, if hired. You also agree that we may verify all data entered on this application and you release Full Life and any person giving or receiving such information from liability.
I agree to the terms above and indicate so by typing my initials in the box.
Click submit to apply for a position in East Hawai'i.