Georgetown Harmony Homes Application
Georgetown Harmony Homes is an equal Opportunity Employer
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Type of work you are seeking (check all that apply) *
Required
Name *
Street Address *
City *
State *
Zip *
Cell Phone *
Email address *
Home Phone *
How did you hear about this position? *
Why are you interested in this position? *
Are you at least 18 years old? *
Required
Have you applied here before? *
Required
If yes, give date:
Have you ever been employed here before? *
Required
If yes, give dates and reason for leaving.
Are you legally eligible for employment in this country? *
Required
Date available for work? *
MM
/
DD
/
YYYY
Placement Desired *
Required
Do you have any restrictions on the hours you can work? *
Required
If yes, please explain
Have you had at least one year experience working with persons experiencing developmental disabilities? *
Required
If yes, please describe
If applying for a position that requires driving, do you have a valid driver's license? *
Required
If no, please explain
Have you been provided a job description for the position for which you are applying? *
Required
Are you able to perform the essential functions of the position, with or without accommodation? *
Required
Georgetown Harmony Homes requires a copy of all original education and training certificates in order to verify that you meet the requirements of any job for which you are applying.
Please type N/A if Not applicable
High School Diploma or GED obtained? *
Required
Higher Education
Enter N/A if not applicable
School
Location
Highest level completed
Degree or Diploma
Major
School
Location
Highest level completed
Have you received training from the Michigan Department of Health and Human Services, or Community Mental Health? *
Required
If yes, explain what training:
Other current certifications such as CPR, First Aid
Summarize special skills and qualifications you acquired from prior employment, training, or experiences that may qualify you for a job within this organization. *
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