Thank you for considering being a part of our team!

Phone: 541-600-8799  

Fax: 541-653-9998

1500 Valley River Drive, Suite #330

Eugene OR 97402

Notice: False or misleading information provided on this application or during interviews, if discovered after employment, may result in discharge. We do not discriminate because of gender, age, race, ethnic background, religion, disability, sexual orientation, marital status or political beliefs and affiliations. This is not an employment contract.
Name *
Available For *
Shift Availability *
Weekly Availability (of the following, select the days of the week you are available for work) *
May We Contact
High School/GED Graduate? *
College Graduate *
Employment Eligibility *
Driving Information
Most daytime and evening positions require that you have a valid Oregon Driver’s License, are aged 18 or over and have no or minimal driving infractions. If hired, these factors determine your ability to be covered by the agency’s insurance carrier and may limit what hours and days you can work.In order to process your application, we need your Driver's License Number. Please also be advised that we require an Oregon Driver's License in order to complete the hiring process with you.
Oregon DHS Protective Services Devision
Oregon DHS requires that we ask the following question.
Abuse Allegations *
Have you ever had an abuse/neglect allegation brought against you which was found to be substantiated?
Physical Requirements
Some aspects of the job have certain physical/health requirements, such as: physical transferring, lifting, bending and stooping and may request that you lift up to 50 pounds.
Physical Duties *
Are you able to perform the physical duties as described above with or without reasonable accommodation?
If you answered No above or need reasonable accommodations, please describe:
Agreements and Authorizations
By signing or typing your name below, you agree to the following as part of the application process: I authorize investigation of all statements contained in this application as may be deemed necessary for an employment decision. All test results and records are confidential. I understand that any employment offered by this firm is of an "at will" nature, meaning that I may quit at any time, and the company may discharge me at any time, with or without cause, and that if hired, I am required to abide by all rules and regulations of this company. I understand that this application will be active for only 60 days; and if I want to be considered for a job after that time, I must reapply by completing a new application. I certify that the answers given on this application are complete and true to the best of my knowledge.
Agreements and Authorizations Please enter your full name below. This will serve as your signature on this application for employment.