Employment Application - New Heights Community Support

Education

High School Name

High School Address

From

Did you graduate?

Degree

College Name

College Address

From

Did you graduate?

Degree

Other Name

Other Address

From

Did you graduate?

Degree

References

Please list three professional references.

Full Name *

Relationship *

Company *

Phone *

Address *

Full Name *

Relationship *

Company *

Phone *

Address *

Full Name *

Relationship *

Company *

Phone *

Address *

Previous Employment

I authorize the release of any employment and disciplinary records from all of the previous employers listed below to New Heights Community Support

Company Name *

Company Address *

Phone *

Supervisor Name *

Job Title *

Starting Salary *

Ending Salary *

Responsibilities *

From *

To *

Reason for leaving *

May we contact your previous supervisor for a reference? *

Yes

Company Name

Company Address

Phone

Supervisor Name

Job Title

Starting Salary

Ending Salary

Responsibilities

From

Reason for leaving

May we contact your previous supervisor for a reference?

Yes

Company Name

Company Address

Phone

Supervisor Name

Job Title

Starting Salary

Ending Salary

Responsibilities

From

Reason for leaving

May we contact your previous supervisor for a reference?

Yes

Military Service

Branch

From

Rank at discharrge

Type of dicharge

If other then honorable, explain

Demographic Information

Demographic Information: In order to meet State and Federal reporting requirem ents, we are requesting that you voluntarily supply the following information. This data will not be considered in the evaluation of your application.

Sex

Male

Female

Race/Ethnicity

Essay Questions

Describe your philosophy on providing treatment for persons with substance abuse and/ or mental needs. *

If you were faced with an aggressive or physically attacking individual, how would you handle the situation? *

What do you think are the goals of community-based treatment? *

What is the difference between therapeutic and social relationship? Which is more appropriate when working with special *

What do you consider to be the best practice approaches in the substance abuse and mental health field? *

I certify that the statements made by me on this application are true and complete to the best of my knowledge and are made in good faith. I understand that if I knowingly make any misstatement offact, I am subject to disqualification and dismissal and to such other penalties as may be prescribed by law or personnel regulations. All statements made on this application, including employment information, are subject to verification as a condition of employment.

Signature *

Date *

Please type in the verification code *

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