Ability and Choice Services, Inc. On-Line Application If you need to continue on an application you started earlier, click here
Background Clearance Since all positions are working with vulnerable adults or children and require passing a background screening, do you have anything on your record which would cause you to fail the background check requirements as required by Medicaid, Federal and State laws (click here for more info, in general no felonies in the last 10 years, no class A or B misdemeanors in the last 5 and no child abuse or domestic violence convictions)?: -- Yes No Comments:
Driving Record Most positions require operating a motor vehicle, do you have a Valid Driver's License? -- Yes No , State: -----NebraskaOklahomaOhioNorth DakotaNorth CarolinaNew YorkMontanaNew MexicoNew JerseyNew HampshireNevadaOregonPennsylvaniaRhode IslandVermontWyomingWisconsinWest VirginiaWashingtonVirginiaUtahTexasTennesseeSouth DakotaSouth CarolinaMissouriMississippiMinnesotaHawaiiGuamGeorgiaFloridaDistrict Of ColumbiaDelawareConnecticutColoradoCaliforniaArkansasArizonaIdahoIllinoisMichiganMassachusettsMarylandMaineLouisianaKentuckyAlaskaKansasIowaAlabamaIndiana <<<<< Military >>>>>Armed Forces AfricaArmed Forces PacificArmed Forces Americas <<<<< Misc >>>>>American SamoaVirgin IslandsPuerto RicoPalauMariana IslandsMarshall IslandsMicronesia Do you have more than two moving violations in the past three years or restrictions or accidents in the past five years? -- Yes No , Explain: