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Return to Employment Opportunities

PLEASE READ CAREFULLY: The Homestead is committed to the policy that all persons have equal access to its employment, programs and facilities without regard to race, color, religion, sex, national origin, age, or disability. It is the applicant’s responsibility to request any special arrangements needed to facilitate the application process.

Name (first,middle,last):
What are you interested in?  Check one. 

Employment InternshipBoth
Full or Part-time employment?  Check one. 

Full Time Part Time
Address1:
Address2:
Address3:
City:
State:
Zip:
Home Phone:
BusinessPhone:
Email Address:
Job Desired
Shift Availability:
On what date can you be available to start work?
Are you a relative of any current employee at The Homestead?  NoYes
If yes, please name these relatives:
Do you have a record of founded child or dependent adult abuse?

NoYes
Have you ever been convicted of a crime in this state or any other state, or is there a charge which is still pending?

NoYes
If yes, explain:
EDUCATION:
If you attended school under another name, please state name:
College or University

Name:

Location:

Courses of study:

Diploma/Degree:
Business/Trade School/
Specialized Training

Name:

Location:

Courses of study:

Diploma/Degree:
High School

Name:

Location:

Courses of study:

Diploma/Degree:
Military Training

Name:

Location:

Courses of study:

Diploma/Degree:
If licensed, registered, or certified, please provide the following information:

Your Number:

State:

Your Field:

Expiration Date:
EMPLOYMENT:
From (Mo/Yr):
To (Mo/Yr):

Full Time or Part Time?

Employer:

Address:

Phone Number:

Job Title:

Reason for Leaving:
Starting Salary:
Last Salary:
Supervisor:
May we contact this employer?:

NoYes


From (Mo/Yr):
To (Mo/Yr):

Full Time or Part Time?

Employer:

Address:

Phone Number:

Job Title:

Reason for Leaving:
Starting Salary:
Last Salary:
Supervisor:
May we contact this employer?:

NoYes


From (Mo/Yr):
To (Mo/Yr):

Full Time or Part Time?

Employer:

Address:

Phone Number:

Job Title:

Reason for Leaving:
Starting Salary:
Last Salary:
Supervisor:
May we contact this employer?:

NoYes


From (Mo/Yr):
To (Mo/Yr):

Full Time or Part Time?

Employer:

Address:

Phone Number:

Job Title:

Reason for Leaving:
Starting Salary:
Last Salary:
Supervisor:
May we contact this employer?:

NoYes
EMPLOYMENT REFERENCES
Name
Address
Phone
Name
Address
Phone
Name
Address
Phone
How did you hear about The Homestead?
If Newspaper or Friend, please specify:

By submitting this application you are stating that you understand and agree with the following statements:

I authorize the investigation of all matters, including your employment history, contained in this application. I understand and agree that if, in the judgement of The Homestead, the results of the investigation are not satisfactory, any offer of employment made by The Homestead may be withdrawn or my employment with The Homestead may be terminated. I authorize the references listed in this application, including personal and employment references and all prior employers, to provide you with all information pertinent to this application. I release all parties from liability for any damages which may result from the release of any information as part of the employment verification process.

All successful applicants must pass a physical exam which includes a drug test prior to beginning employment at The Homestead. I understand that an offer of employment is contingent upon my passing The Homestead medical examination before starting work. The examination may include a demonstration of my ability to perform the essential functions of the job. If the examination discloses conditions that prevent me from safely and successfully performing the essential functions of the job, The Homestead will attempt to make accommodations that will enable me to work. If no reasonable accommodations can be found, or if such accommodations impose undue hardship on The Homestead, the offer of employment will be withdrawn.

I acknowledge and I understand that The Homestead has a policy of employment at will, and if I am hired by The Homestead, my employment may be terminated either by myself or by The Homestead at any time. I acknowledge that I have been advised that this application will remain active for 1 year from this date.