Welcome to NYC Social Care
Please complete the form below to apply for a position with our team.
Today's Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
*
First Name
Last Name
Preferred Name (if different from First Name)
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Home Computer Type
Mac
Windows
Are you able to legally work in the United States of America?
*
Yes
No
What days & times can you work?
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Morning
Afternoon
Neither
Both
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Work experience relative to this position (If currently employed, please list employers name and your current job title or position)
Any additional information you would like to tell about yourself?
Signature
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Were you referred by someone?
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