Help in the Home, LLC Employee Application
Help in the Home, LLC is an Equal Opportunity Educational Institution and EEO/Affirmative Action Employer committed to excellence through diversity. Employment offers are made on the basis of qualifications, and without regard to race, sex, religion, national or ethnic origin, disability, age, veteran status, or sexual orientation.
Full Name *
Include First, M.I., Last
Your answer
Address *
Include street address, city, state and zip code
Your answer
Phone Number *
Your answer
Email address *
Your answer
Date available for work *
Your answer
Social security number
Your answer
Desired Salary
Please include as a hourly rate
Your answer
Are you a citizen of the United States? *
Please answer yes or no. If no, are you authorized to work in the United States?
Your answer
Have you ever worked for this company before? *
Please answer yes or no. If so, when?
Your answer
Have you ever been convicted of a felony? *
Please answer yes or no. If yes, explain.
Your answer
Have you ever had charges, arrests, or convictions for a crime including sex-related offenses brought against you? *
Please answer yes or no. If yes, explain.
Your answer
Education
High School *
Please include name of school, address, dates attended, degree given
Your answer
College *
Please include name of school, address, dates attended, degree given
Your answer
Graduate School
Please include name of school, address, dates attended, degree given
Your answer
Other
Please include name of school, address, dates attended, degree given
Your answer
References
Please list three professional references
Reference 1 *
Please list full name, relationship, company, phone number and address
Your answer
Reference 2 *
Please list full name, relationship, company, phone number and address
Your answer
Reference 3 *
Please list full name, relationship, company, phone number and address
Your answer
Previous Employment
Previous employer 1
Please list company, phone number, address, supervisor, job title, starting and ending salary, responsibilities, dates worked there, reason for leaving
Your answer
May we contact your previous employer 1 for a reference? *
Previous employer 2
Please list company, phone number, address, supervisor, job title, starting and ending salary, responsibilities, dates worked there, reason for leaving
Your answer
May we contact your previous employer 2 for a reference? *
Previous employer 3
Please list company, phone number, address, supervisor, job title, starting and ending salary, responsibilities, dates worked there, reason for leaving
Your answer
May we contact your previous employer 3 for a reference? *
Military Service
Military Branch
Please list branch, dates of service, rank of discharge, type of discharge
Your answer
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
I understand that a photocopy of this application may be used in lieu of the original.

If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.

Signature *
I understand that entering my name in this box will constitute my digital signature
Your answer
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