Pre Screen Application – Springs of Life Recovery

Pre-Screen Application

Please fill out the below application and you will be contacted within 72 hours.

Referred by:(Required)

Approximate Desired Entry Date(Required)

Name(Required)

State of Residence(Required)

Age(Required)

Please enter a number from 1 to 100.

Phone Number(Required)

Email(Required)

Please select the following that apply:

Can you provide a picture ID of FaceSheet?

Have you ever had a violent offence?

Have you ever had a sex offense?

Do you have any outstanding charges?

Are you able to pass a drug test upon entry?

Are you married?

Do you have children?

55131

Address: P.O. Box 893, Jellico, TN, 37762

Email: branamcliff@yahoo.com