Application

Step 1 of 6 - Basic Information

16%

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Resume/CV Upload
Accepted file types: pdf, doc, docx, odf, txt, rtf, Max. file size: 256 MB.

Work Experience #1
Employer*
Start Date*
End Date
Leave this blank if you are still working for this employer.
Description*
Please briefly describe your role at the company.
Additional Experience?*
- Yes
- No
Work Experience #2
Employer
Start Date
End Date
Leave this blank if you are still working for this employer.
Description
Please briefly describe your role at the company.
Additional Experience?*
- Yes
- No
Work Experience #3
Employer
Start Date
End Date
Leave this blank if you are still working for this employer.
Description
Please briefly describe your role at the company.

Have you ever been involuntarily terminated or asked to resign from any job?*
- Yes
- No
If yes, please explain
Please explain any gaps in your employment history:
Please list any other experience, job related skills, additional languages, or other qualifications that you believe should be considered in evaluating your qualifications for employment.

Education*
Name Year Completed Area of Study
References*
Name Relationship Phone Number

Have you ever used another name?*
- Yes
- No
Is any additional information relative to name changes, use of an assumed name, or nickname necessary to enable a check on your work and educational record?*
- Yes
- No
If yes to either of the above, please explain:
Have you ever worked for this company before?*
- Yes
- No
If yes, please give dates and position
Do you have friends and/or relatives working for this company?*
- Yes
- No
If yes, please give names and relationship(s)
Availability*
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Are you available to work*
- Full-time
- Part-time
- Shift-work
- Temporary
Minimum salary required*
If hired, would you have a reliable means of transportation to and from work?*
- Yes
- No
Can you travel if the position requires it?*
- Yes
- No
Can you relocate if the position requires it?*
- Yes
- No
Are you at least 18 years old?*
- Yes
- No
If under 18, hire is subject to verification that you are of minimum legal age.
If hired, can you present evidence of your identity and legal right to work in this country?*
- Yes
- No
Are you able to perform the essential job functions of the job for which you are applying with or without reasonable accomodation?*
- Yes
- No
We comply with ADA and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions.

APPLICANT STATEMENT AND AGREEMENT*
- I hereby authorize the Company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
- In the event of my employment with the Company, I understand that I am required to comply with all rules and regulations of the Company.
- If hired, I understand and agree that my employment with the Company is at-will, and that neither I, nor the Company is required to continue the employment relationship for any specific term. I further understand that the Company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.
- I understand that safety of employees is extremely important to the Company and that the Company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health.
- I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
- I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard.
- I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed and the remainder of this Agreement shall be enforceable.
Please read each paragraph and check each box. If there is anything that you do not understand, please ask.
MY SIGNATURE BELOW ATTESTS TO THE FACT THAT I HAVE READ, UNDERSTAND, AND AGREE TO ALL OF THE ABOVE TERMS.
Signature

Δ

Navigate

About
What We Do
Success by the Numbers
Careers
Contact
Job Listings

Contact

115 Main St.
Suite 3
Bangor, Maine 04401
Phone: (207) 433-0088
Email: info@dragonflyls.com

Dragonfly Therapy

Name	Year Completed	Area of Study

Name	Relationship	Phone Number

Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday

Application

Application

Step 1 of 6 - Basic Information

Work Experience #1

Work Experience #2

Work Experience #3