Application - Residential DSP Sleep Night : Career Opportunities : Development Homes, Inc.

PERSONAL INFORMATION

First and Last Name

First Name *

Last Name *

Street Address, City, State and Zip Code

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Phone (Required)

Please enter in this format (###)###-####

Cell Phone

Please enter in this format (###)###-####

E-mail Address (Required)

List all names if different during any employment listed

POSITION

Please indicate which position you are applying for (Required)

Preferred Location

Job Order Number (if known)

Please enter in this format ###-20

Would you be able to work every other weekend? (Required)

Are you 18 years of age or older? (Required)

Are you eligible to work in the United States? (Required)

Do you have a high school diploma or equivalent? (Required)

Have you ever been employed by DHI? (Required)

If yes, when?

Month

Day

Year

Please list the dates

If yes, last name while employed at DHI

EDUCATION

Vocational/College Name

Address, City, State and Zip

Country

Address Line 1

City

State/Province

Postal Code

Did you graduate?

Degree or Major

EMPLOYMENT EXPERIENCE HISTORY

List below all present and past employment, beginning with your most recent, include any job-related military service assignment and volunteer activities. Applications must be complete for consideration. "See resume" is NOT considered complete.

(Required)

Name and Address of Company Required

Dates employed

Start Date

–

End Date

Job Title: (Required)

Summary of duties: (Required)

Reason for leaving: (Required)

Supervisor: (Required)

May we contact for a reference? (Required)

Phone Number: (Required)

Please enter in this format (###)###-####

Name and Address of Company (Required)

Dates employed

Start Date

–

End Date

Job Title: (Required)

Summary of duties: (Required)

Reason for leaving: (Required)

Supervisor: (Required)

May we contact for a reference? (Required)

Phone Number: (Required)

Please enter in this format (###)###-####

q2eeaq5ypimj

Name and Address of Company (Required)

Dates employed

Start Date

–

End Date

Job Title: (Required)

Summary of duties: (Required)

Reason for leaving: (Required)

Supervisor: (Required)

May we contact for a reference? (Required)

Phone Number: (Required)

Please enter in this format (###)###-####

CERTIFICATIONS

Are you currently a Certified Nursing Assistant (CNA)? (Required)

Have you achieved DD Certification through Minot State University? (Required)

Experience Relative To This Position

List any training, education, employment, volunteer work, or other experiences that have equipped you to work with adults and/or children with disabilities: (Required)

Why do you want to work with adults and/or children with disabilities? (Required)

MOTOR VEHICLE INFORMATION

Do you have a current and valid Driver's License? (Required)

Do you have automobile insurance on your vehicle? (Required)

(You will be required to show proof of this upon hire.)

Applicants will be screened for driving violation through the Department of Motor Vehicles. All job offers are contingent on a successful and insurable MVR.

Have you had any violations on your driving record over the last three years? (Required)

If, yes please explain

BACKGROUND CHECK INFORMATION

Have you EVER been convicted of a misdemeanor or felony crime? (Required)

If yes, give date(s) and offense(s)

Have you ever been required by any licensing board or professional ethics body to surrender your license or been found guilty of professional ethics code violations or professional misconduct? (Required)

If yes, give date(s) and please explain

REFERRAL SOURCE

How did you hear about Development Homes? (Required)

IF EMPLOYEE REFERRAL PLEASE LET US KNOW WHO

Name of the DHI employee who referred me

First Name

Last Name

REFERENCES

Please list three professional references that you have known for at least 1 year. Please fill out all information completely.

First and Last Name

First Name *

Last Name *

Company Name: (Required)

Relationship: (Required)

Phone Number: (Required)

Please enter in this format (###)###-####

First and Last Name:

First Name *

Last Name *

Company Name: (Required)

Relationship: (Required)

Phone Number: (Required)

Please enter in this format (###)###-####

First and Last Name:

First Name *

Last Name *

Company Name: (Required)

Relationship: (Required)

Phone Number: (Required)

Please enter in this format (###)###-####

APPLICANT'S STATEMENT

I certify that the information I have provided on this application is true and complete to the best of my knowledge. I authorize Development Homes, Inc. (DHI) to investigate my work history and verify data given on this application, on related papers, and in interviews. Any misrepresentation or omission of any facts may result in denial of employment or if employed, termination.

I understand that DHI follows an “employment at will” policy, in that I or the employer, may terminate my employment at any time, or for any reason consistent with applicable state or federal law. I understand that this application is not a contract for employment.

I authorize DHI to conduct reference checks from either my previous or current employers. I provided employment or personal references and authorize DHI to conduct reference checks. I fully release all parties, from all liability for damages or claims which may arise or result from any reference information gathered pursuant to this authorization.

My typed electronic signature below indicates that I agree to all of the above terms.

Electronic Signature: (Required)

Date of Electronic Signature: (Required)

ABUSE PREVENTION APPLICANT STATEMENT AND AGREED CODE OF CONDUCT

I understand that my references and contacts from prior volunteer or employment with vulnerable adults and or children, students, or disabled adults may be contacted and that an appropriate criminal background check will be conducted. I understand that I must be interviewed and screened before I begin my employment, if an employment offer is made. I understand that I may withdraw from being considered for employment at any time.

I attest that I am not a pedophile or child molester and have not perpetrated physical abuse, sexual abuse, emotional abuse, or neglect against a vulnerable adult and or child, a student, or disabled adult, and I have never been accused of these acts.

I understand that Development Homes, Inc. (DHI) has a policy of zero tolerance for abuse and neglect and takes all allegations of abuse and neglect seriously. I further understand that DHI cooperates fully with the authorities to investigate all cases of alleged abuse. Substantiated abuse and/or neglect may be grounds for immediate termination and possible criminal charges.

I also understand any false statements regarding past conduct and or present, and refusal to inform DHI of the contents of a sealed criminal record will result in denial of employment or if employed, termination.

My typed electronic signature below indicates that I agree to all of the above terms.

Electronic Signature: (Required)

Date of Electronic Signature: (Required)

EQUAL EMPLOYMENT OPPORTUNITY (EOE) STATEMENT

Development Homes, Inc. (DHI) provides Equal Employment Opportunity (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability (physical or mental), marital status, veteran status, pregnancy, sexual orientation, gender identity, genetic information, or any other non-merit-based factor. In addition to federal law requirements, DHI complies with applicable state and local laws governing nondiscrimination in employment. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfers, leaves of absence, compensation, and training.

Development Homes expressly prohibits any form of workplace harassment based on race, color, religion, sex, national origin, age, disability (physical or mental), marital status, veteran status, pregnancy, sexual orientation, gender identity, genetic information, or any other non-merit-based factor.

DHI embraces Equal Employment Opportunity (EEO) and is committed to fostering an inclusive workforce that reflects diversity.