Fields marked (*) are required

First Name:*	Last Name:*
Your Email Address:*	Daytime Telephone:*
Evening Telephone	Best Time to Call
Address	City, State, Zip
Type of Senior Living desired
Assisted Living Alzheimer's Care Respite Care-Short Term Stay	What is your anticipated time-frame for making the transition to assisted living? Immediately Within 6 months 6 months to a year Greater than 1 year from now
Are you making this inquiry for yourself? Yes No	For whom are you inquiring? Mother Father Both Parents Relative Neighbor or Friend Other
Are there any questions we can answer for you today? If so, please use the comment box below.

If a career at The Elms, Chestnut Cottage or The Carriage House interests you, please download and complete the
Employment Application. Please mail it with a cover letter to:

The Elms Retirement Residence
Human Resources
22 Elm Street
Westerly, RI 02891

The Elms keeps employment applications on file for a period of one year.