WIBL Application process

If you are interested in joining the WIBL family, please complete one of the forms below. If you are interested in living in the WIBL house, apply to the residential program. If you are interested in only working at WIBL, apply to the work program. We will contact you to let you know if we are accepting new associates and if so, to schedule an interview.

Residential + Work Application Form

Full Name

First Name

Last Name

Alias (if applicable)

Phone

(###)

###

####

Date of Birth

YYYY

Race

Address (Street, City, State)

Emergency Contact (First and Last Name)

Emergency Contact Relation to Applicant

Emergency Contact Phone Number

(###)

###

####

Referred by:

Do you have children?

Do you have medical insurance?

Do you have a history with addiction?

Do you have a history of being a victim of sexual abuse?

Do you have a history of prostitution?

Have you experienced domestic violence?

Do you receive any monthly income?

List any inpatient and/or recovery programs in which you have participated.

Have you ever received a mental health diagnosis?

Do you have any physical disabilities, chronic, or ongoing conditions that would interfere with lifting of furniture or climbing steps?

Are you currently taking any medications?

Have you been hospitalized for psychiatric reasons?

Have you ever attempted suicide?

Do you have pending charges or warrants?

Are you on probation?

What is your highest level of education?

Describe your work history:

Work Program Application

Full Name

First Name

Last Name

Alias (if applicable)

Phone

(###)

###

####

Date of Birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact (First and Last Name)

Emergency Contact Relation To Applicant

Emergency Contact Phone Number

(###)

###

####

Referred by:

Do you have a history with addiction?

Do you have a history of being a victim of sexual abuse?

Do you have any physical disabilities, chronic, or ongoing conditions that would interfere with lifting furniture or climbing steps?

What is your highest level of education?

Describe your work history:

How to Apply