Employment – H.O.P.E., Inc.

H.O.P.E., Inc. is an equal opportunity employer. Please complete the form below in you are interested in obtaining employment through H.O.P.E., Inc.

Today's Date *

Name *

First

Last

Date of Birth *

REQUIRED TO RUN MOTOR VEHICLE INSURANCE CHECK

Social Security Number *

REQUIRED TO PERFORM BACKGROUND CHECK

Email *

Primary Phone Number *

Secondary Phone Number

Present Address *

Referred By

Position Seeking *

Please check all shifts you would be willing to work.

Date You Can Start

Desired Salary *

Certifications

Please check all items that you currently hold valid certification for and can provide a copy.

Have you ever been convicted of a felony? *

NOTICE: The Alabama Department of Mental Health prohibits providers of ID/DD services from employing individuals with a felony on his/her background.

Do you possess a valid Driver's License? *

Notice: A valid driver’s license with an acceptable driver record, as determined by an MVR, is required.

Driver's License (State and Number) *

REQUIRED TO PERFORM BACKGROUND CHECK AND MVR

Are you currently employed?

If yes, where?

Highest Level of Education *

Please choose the highest level you have completed. Minimum of GED/High School diploma is required.

Name, Dates of Employment, and Phone Number of Last Employer *

Name, Dates of Employment, and Phone Numbers of Previous Employers

References *

Please list 3 references with phone numbers.