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Companion Application

Ready to become a Companion? Fill out Villi Companion Application and an Advisor will contact you within 24-48 business hours.

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Applicant
Are you willing/able to provide transportation by driving a client's vehicle?*
Are you willing/able to provide client transportation by using your vehicle?*
Do you have a registered automobile, required insurance and driver’s license?*
What is your highest level of education?*
Please list prior work, volunteer or personal experience: (Select all that apply)*


What is your current Work Status? (Select all that apply)*
Schedules may vary, and hours are not guaranteed. Based on this, how many hours per week would you like to work? (Select all that apply)*
What times of day would you prefer to work? (Select all that apply)*
Which language(s) do you speak fluently? (Select all that apply)*
How did you hear about us? (Select all that apply)*
Receive future communications?

Voluntary Self-Disclosure of Race/Ethnicity and Gender

Villi is an Equal Opportunity Employer and is subject to certain nondiscrimination and affirmative action recordkeeping and reporting requirements which require the Company to invite employees/applicants to voluntarily self- identify their race/ethnicity and, gender.

Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment or be used when considering you for employment with our company. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable federal laws, executive orders, and regulations, including those which require the information to be summarized and reported to the Federal Government for civil rights enforcement purposes.

Please mark the one box that describes the race/ethnicity category with which you primarily identify:*
Gender*

Voluntary Self-Identification of “Protected” Veteran Status

The company is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA). VEVRAA requires Government contractors to take affirmative action to employ and advance in employment protected veterans. To help us measure the effectiveness of our outreach and recruitment efforts of veterans, we are asking you to tell us if you are a veteran covered by VEVRAA. Completing this form is completely voluntary, but we hope you fill it out. Any answer you give will be kept private and will not be used against you in any way.

How Do You Know if You Are a Veteran Protected by VEVRAA?

Contrary to the name, VEVRAA does not just cover Vietnam Era veterans. It covers several categories of veterans from World War II, the Korean conflict, the Vietnam era, and the Persian Gulf War which is defined as occurring from August 2, 1990 to the present.

“Protected” veterans include the following categories: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These categories are defined below.

  1. A “disabled veteran” is one of the following:
    • a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or
    • a person who was discharged or released from active duty because of a service-connected disability.
  2. A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
  3. An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
  4. An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
If you believe you belong to any of the categories of protected veterans please indicate by checking the appropriate box below:*

Voluntary Self-Identification of Disability

Why are you being asked to complete this form?

We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.
Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do I know if I have a disability?

A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

  • Alcohol or other substance use disorder (not currently using drugs illegally)
  • Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS
  • Blind or low vision
  • Cancer (past or present)
  • Cardiovascular or heart disease
  • Celiac disease
  • Cerebral palsy
  • Deaf or serious difficulty hearing
  • Diabetes
  • Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders
  • Epilepsy or other seizure disorder
  • Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome
  • Intellectual or developmental disability
  • Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD
  • Missing limbs or partially missing limbs
  • Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports
  • Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS)
  • Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities
  • Partial or complete paralysis (any cause)
  • Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema
  • Short stature (dwarfism)
  • Traumatic brain injury

Form CC-305, OMB Control Number 1250-0005, Expires 04/30/2026

Please check one of the boxes below to indicate your disability status:*

PUBLIC BURDEN STATEMENT

According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.
REQUESTS FOR REASONABLE ACCOMMODATION TO PARTICIPATE IN THE APPLICATION PROCESS
If you require an adjustment or change concerning some aspect of the application process, you may request a reasonable accommodation at any time, orally or in writing. To contact a company representative in writing regarding a request for reasonable accommodation to apply, please email your local office or [email protected], or write to us at Villi c/o Employee Relations Department, 7227 Lee Deforest Drive, Columbia MD 21046. To speak with a Villi representative in order to request a reasonable accommodation to apply, please call our Employee Relations hotline at 866-915-6481.
This field is for validation purposes and should be left unchanged.
Contact

844-624-JOIN

[email protected]

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Contact

844-624-JOIN

844-624-5646

[email protected]