Hope Homes

Application for Employment Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.
Date of Application	/ /
Last Name
First Name
Middle Name
Present Address
City
State
Zip Code
Telephone
Mobile/Beeper/Other
Email Address
Referral Source Please name source where applicable
Walk-In
Employee
Advertisement
Company's Website
Other Internet
School
Job Fair
Staffing Agency
Government
Employment Agency
Other

If necessary, best time to call you is
May we call you at work?	yes no
If yes, work number and best time to call
If you are under 18 and it is required, can you finish a work permit?	yes no
If no, please explain
Have you submitted an application here before?	yes no
If yes, give date(s) and position(s)
Have you ever been employed here before? If yes, give dates	/ to /
Are you legally eligible for employment in this country?	yes no
Date available for work	/
What is your desired salary range?
Type of employment desired	part-time full-time educational co-op seasonal temporary
Will you relocate if job requires it?	yes no
Will you travel if job requires it?	yes no
If they have been explained to you, are you able to meet the attendance requirements of the position?	yes no N/A
Will you work overtime if required?	yes no
If no, please explain
Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation)? This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.	yes no Need more information about the job's "essential functions" to respond

Driver's license number may be required in the job for which you are applying.
DL State
Have you ever been bonded?	yes no
Answering "yes" to the following questions does not constitute an automatic dismissal for employment. Factors such as offense, seriousness and position applied for will be taken into account.
Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?	yes no
If "yes", please provide dates and detail(s)
Have you entered into an agreement with any former employer or other party (such as a non-competition agreement) that might, in any way, restrict your ability to work for our company?	yes no
If yes, please explain
Employment History Starting with your most recent employer, provide the following information.
Address
City
State
Zip Code
Telephone
May we contact for reference?
Starting job title
Immediate supervisor and title (for most recent position held)
Why did you leave?
Summarize the type of work performed and job responsibilities
What did you like most about your position?
What were the things you liked least about the position?
Date employed	/ to /
Compensation (starting)
Compensation (final)

Address
City
State
Zip Code
Telephone
May we contact for reference?
Starting job title
Immediate supervisor and title (for most recent position held)
Why did you leave?
Summarize the type of work performed and job responsibilities
What did you like most about your position?
What were the things you liked least about the position?
Date employed	/ to /
Compensation (starting)
Compensation (final)

Address
City
State
Zip Code
Telephone
May we contact for reference?
Starting job title
Immediate supervisor and title (for most recent position held)
Why did you leave?
Summarize the type of work performed and job responsibilities
What did you like most about your position?
What were the things you liked least about the position?
Date employed	/ to /
Compensation (starting)
Compensation (final)

Explain any gaps in your employment, other than those due to personal illness, injury or disability.
Have you ever been fired or asked to resign from a job?	yes no
If yes, please explain
Skills and Qualifications
Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying.
Computer Skills
Word Processing	years
Spreadsheet	years
Presentation	years
Email	years
Internet	years
Other
Educational Background Starting with your most recent schooling, please provide the following
School Name
Years Attended	to
	Diploma Degree Certification Other
Course of Study

School Name
Years Attended	to
	Diploma Degree Certification Other
Course of Study

School Name
Years Attended	to
	Diploma Degree Certification Other
Course of Study
References List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.
Name
Title
Telephone
Relationship
Years Known

Name
Title
Telephone
Relationship
Years Known

Name
Title
Telephone
Relationship
Years Known
Related Information
To what job-related organizations (professional, trade, ete.) do you belong? Exclude information that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status.
List special accomplishments, publications, awards, etc. Exclude information that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status.
In your current or a prior job, have you ever written instructions or directions to be followed by employees or customers?	yes no
If yes, please explain
Is there any other job-related information you want us to know about you?
Applicant Statement
By pressing submit, I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with ot without cause and with or wimout prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identiry and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. This Company does not tolerate unlawful disriination in its employment practices. No question on this application is used for the purpose of limiting or excluding and applicant from consideration for employment on the basis of his sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state, and local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status. Examples of prohibited harassment include, but are not limited to, unwelcome physical contact, offensive gestures, unwelcome comments, jokes, epithets, threats, insults, name-calling, negative stereotyping, possession or display of derogatory pictures or other graphic materials, and any other words or conduct that demean, stigmatize, intimidate, or single out a person because of his/her membership in a protected category. Harassment of our employees in strictly prohibited, whether it is committed by a manager, coworker, subordinate, or non-employee (such as a vendor or customer). The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.
I, the applicant, authorize the release and use of consumer reports as related to my application.	yes no Sign_________________ Date________ Sign, Date, Print and Mail to: Hope Homes HR Dept. 2300 Call Rd. Stow, Ohio 44224

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