Employment Application (VFI North)

Date of Birth*
First Name*
Last Name*
Middle Name
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Enter Email Confirm Email
Describe Days / Times you’re Available*
Are you applying to work for a specific consumer?*
- Yes
- No
If Yes, what is the consumer's name?

1432 Wilkins Rd. | Erie, PA 16505

Office hours: 8:30 AM to 4:30 PM Monday through Friday

VOICES FOR INDEPENDENCE DOES NOT DISCRIMINATE IN THEIR HIRING PRACTICE; ON THE BASIS OF RACE, CREED, COLOR, ETHNICITY, NATIONAL ORIGIN, RELIGION, SEX, SEXUAL ORIENTATION, GENDER EXPRESSION, AGE, HEIGHT, WEIGHT, PHYSICAL OR MENTAL ABILITY, VETERAN STATUS, MILITARY OBLIGATIONS, oR MARITAL STATUS.