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An extended family home (EFH) creates an opportunity for people with disabilities to live in a private family home while receiving individualized care. Families must go through an extensive screening and training program before being matched with an individual who will move into their home. The EFH can be an ideal transition for individuals who have been living in a group home or independently, but now require more individualized care. The family can provide support with self-care needs, money management, medical care, and leisure/recreational activities.

Extended Family Home Application
Additional Details

Work History

Special Job Skills/Education

Family Dynamic


Home Environment

Applicant Statement

Read thoroughly before signing – ask for clarification if there is something you don’t understand.


I certify that answers given in this application are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this “Application for Employment” as may be necessary in arriving at an employment decision. I authorize any agent of VITAL Services Inc. to contact previous employers and my personal references for the purpose of verifying any information given in this application and for references regarding my character and work history. I further authorize any agent of VITAL Services Inc. to conduct a background check through one or more of the following:  I also authorize any agent of VITAL Services Inc. to access and print my Motor Vehicle Record (MVR) from the internet – upon employment, and also anytime during employment with VITAL Services Inc., in order to satisfy the insurance carrier of my satisfactory driving records.


This application for employment shall be considered active for a period of time not to exceed 60 days.  (Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.)


In the event of employment by VITAL Services Inc., I understand that:


False or misleading information given in my application or interview(s) may result in discharge.

I will be required to authorize downloading a current Motor Vehicle Record at my expense.

I will be required to abide by all Policies and Procedures of VITAL Services Inc.

I will be required to satisfactorily complete all required training within time allowed.

I will be expected to stay informed of all current and revised rules, Policies and Procedures.

I will be expected to get a drug test at NE Occupational Health before orientation or training will begin