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*
*
*
*
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*
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*
*
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*
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*
*
*
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Felony Yes
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Misdemeanor No
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Over 18 No
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Over 18 Yes
*
Work Authorization Yes
*
Work Authorization No
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Misdemeanor Yes
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US Citizen No
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Felony Yes
*
Felony No
*
*
*
*
*
/
*
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*
*
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*
/
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High School Graduate Yes
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No
*
*
*
*
*
/
*
/
*
*
/
*
/
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College Graduate Yes
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College Graduate No
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*
*
*
*
*
*
*
*
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*
*
*
*
*
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/
*
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*
*
/
*
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*
*
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Employer 1 Contact Supervisor Yes
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Employer 1 Contact Supervisor No
*
*
*
*
*
*
*
/
*
/
*
*
/
*
/
*
*
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Employer 2 Contact Supervisor Yes
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Employer 2 Contact Supervisor No
*
*
*
*
*
*
*
/
*
/
*
*
/
*
/
*
*
*
Employer 3 Contact Supervisor Yes
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Employer 3 Contact Supervisor No
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Sunday AM
*
Sunday Noon
*
Sunday PM
*
*
:
*
:
*
*
:
*
:
*
Monday AM
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Monday Noon
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Monday PM
*
*
:
*
:
*
*
:
*
:
*
Tuesday AM
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Tuesday Noon
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Tuesday PM
*
*
:
*
:
*
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:
*
:
*
Wednesday Noon
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Friday PM
*
Thursday Noon
*
*
:
*
:
*
*
:
*
:
*
Thursday AM
*
NOON (12PM-5PM)
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Friday PM
*
*
:
*
:
*
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:
*
:
*
Friday AM
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Friday NOON
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Friday PM
*
*
:
*
:
*
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:
*
:
*
Saturday AM
*
NOON (12PM-5PM)
*
Saturday PM
*
*
:
*
:
*
*
:
*
:
*
Friday AM
*
Essential Functions Yes
*
Essential Functions No
*
*
Bus
*
Self Owned Car
*
Other
*
Work Eligibility Yes
*
Work Eligibility No
*
Foreign Languages Yes
*
Foreign Languages No
*
*
*
*
*
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*
*
/
*
/
*
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*
*
/
*
/
*
*
Personal Care Attendant
*
Other
*
*
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Type
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*
*
*
*
Currently Employed Yes
*
Currently Employed No
*
Currently Employed Yes
*
Currently Employed No
*
*
Dependable Yes
*
Dependable No
*
Eligible For Rehire Yes
*
Eligible For Rehire No
*
Good
*
Fair
*
Poor
*
*
*
*
*
Draw
Type
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Choose your signature image
*
*
/
*
/
*
*
*
Personal Care Attendant
*
Other
*
*
Draw
Type
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*
*
Currently Employed Yes
*
Currently Employed No
*
Currently Employed Yes
*
Currently Employed No
*
*
Dependable Yes
*
Dependable No
*
Eligible For Rehire Yes
*
Eligible For Rehire No
*
Good
*
Fair
*
Poor
*
*
*
*
*
Draw
Type
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*
*
/
*
/
*
*
*
/
*
/
*
*
Personal Care Attendant
*
Other
*
*
Draw
Type
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*
*
Currently Employed Yes
*
Currently Employed No
*
Currently Employed Yes
*
Currently Employed No
*
*
Dependable Yes
*
Dependable No
*
Eligible For Rehire Yes
*
Eligible For Rehire No
*
Good
*
Fair
*
Poor
*
*
*
*
*
Draw
Type
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*
*
/
*
/
*
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Moderate
*
Proficient
*
Limited
*
None
*
Moderate
*
Proficient
*
Limited
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
None
*
Limited
*
Moderate
*
Proficient
*
*
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