* = Required Information

Personal Information

Home Mobile Other
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Yes No
Walk-In Internet Search Job Fair/Event
Referred By Other

Hours Available to Work

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Education

High School

Technical School

College

Professional References

Please provide three Professional references below. Professional references include current /former supervisor, colleague, client, and/or vendor.
Relatives are not considered professional references.


Previous Experience

Employment History

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Yes No

Yes No

History

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Yes No
Yes No
Yes No

I, the undersigned applicant, certify and affirm that, to the best of my knowledge and belief I (“have” or “have not”, as applicable) had a case of abuse, neglect, mistreatment or exploitation substantiated against me. As a condition of submitting this application and in order to verify this affirmation, I further release and authorize Loving Arms, LLC, the Tennessee Department of Intellectual and Developmental Disabilities and the Bureau of TennCare to have full and complete access to any and all current or prior personnel or investigative records, from any party, person, business, entity or agency, whether governmental or non-governmental, as pertains to any allegations against me of abuse, neglect, mistreatment or exploitation and to consider this information as may be deemed appropriate. This authorization extends to providing any applicable information in personnel or investigative reports concerning my employment with this employer to my future employers who may be Providers of DIDD services.

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