Employment Opportunities Online Job Application APPLICATION INFORMATION Full Name: * Address: Address: Address: Address: City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Cell Phone: Email: How did you hear about us? * Referral Facebook ZipRecruiter Craigslist Flyer Other How did you hear about us? Referred By How did you hear about us? Website Employee Other Have you ever worked for this company? Yes No When have you worked for this company? Date Available: Position Applied For: Desired Wage: Are you at least 18 years of age? * Yes No Are you a citizen of the United States? * Yes No Are you authorized to work in the U.S.? Yes No Have you ever been convicted of a felony? Yes No Explain: Do you have a resume you would like to upload with this application? * Yes No Upload Your Resume Drop a file here or click to upload Choose File Maximum upload size: 2MB EDUCATION, CERTIFICATIONS, & LICENSES High School: Address: Address: Address: Address: City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal From: To: Did you graduate? Yes No Diploma: College: Address: Address: Address: Address: City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal From: To: Did you graduate? Yes No Diploma: CPR/FA? Yes No When does it expire? Idaho's Assistance with Medications? Yes No Mandt? Yes No When does it expire? Other: REFERENCES Please list three (3) professional references Full Name: Relationship: Company: Phone: Address: Address: Address: Address: City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Full Name: Relationship: Company: Phone: Address: Address: Address: Address: City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Full Name: Relationship: Company: Phone: Address: Address: Address: Address: City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal PREVIOUS EMPLOYMENT Company: Phone: 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Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Supervisor: Job Title: Starting Wage: Ending Wage: Responsibilities: From: To: Reason for Leaving: May we contact your previous supervisor for a reference? Yes No Company: Phone: Address: Address: Address: Address: City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Supervisor: Job Title: Starting Wage: Ending Wage: Responsibilities: From: To: Reason for Leaving: May we contact your previous supervisor for a reference? Yes No Company: Phone: Address: Address: Address: Address: City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Supervisor: Job Title: Starting Wage: Ending Wage: Responsibilities: From: To: Reason for Leaving: May we contact your previous supervisor for a reference? Yes No MILITARY SERVICE Branch: From: To: Rank at Discharge: Type of Discharge: If other than honorable, explain: JOB REQUIREMENTS Part of your job description may include driving a personal or company vehicle. Do you have a current Idaho driver’s license? Yes No Driver’s License #: Expiration Date: Your position may necessitate driving your personal vehicle. Do you have at least the minimum liability insurance required by Idaho for your vehicle? Yes No List any driving violations (tickets, accidents) that may affect your ability to be covered by the agency’s insurance: Do the seatbelts in your personal vehicle work properly? Yes No Do you have seatbelts in the back seat of your vehicle (children ride in the back)? Yes No Your job may include driving with a client in your personal vehicle in the community and surrounding areas (i.e.: Boise, Nampa, and Meridian). Employees driving with clients in their vehicle may be reimbursed a set rate upon submission of required documentation. Is your transportation reliable? Yes No We are required by law to ensure that individuals hired do not have a conviction or prior employment history of abuse, neglect, mistreatment, or exploitation o f a child or vulnerable adult. If hired, your employment will be contingent upon passing a Department of Health & Welfare Criminal History and Background Check, done by their Criminal History Investigation Unit. This background check includes fingerprinti ng and accesses all records including convictions, withheld judgments, adult/child protection records and sealed juvenile records. Please list issues that this background check might uncover: Note: An arrest or conviction on your record does NOT automatically disqualify you for employment. This will be considered on a case-by-case basis. The results of your criminal history check will be compared with your application. Failure to disclose such information on your application may result in termination. Do you have a communicable disease? Yes No If yes, feel free to explain: Tomorrow’s Hope requires pre - employment drug testing for all employees. Will this be a problem for you? Yes No Note: any job offer will be contingent upon taking and passing a drug test. PRE - INTERVIEW QUESTIONS Do you have any experience, paid or unpaid, working with people with Developmental Disabilities? Please explain: Give your definition of Active Treatment: What is Positive Reinforcement? When should it be used? What are your strengths and weaknesses? What are your expectations from Tomorrow’s Hope as an employer? DISCLAIMER AND SIGNATURE I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. Signature Clear Date: reCAPTCHA Submit
