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Helping Hand Center
Application for Employment

"The Mission of Helping Hand Center is to assist persons with disabilities achieve
their highest level of independence through quality programs and services."

NOTICE TO APPLICANT

Helping Hand Center is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation or any other classification protected by federal, state or local law.

Helping Hand Center complies with Section 503 of the Rehabilitation Act of 1973, as amended, 26 U.S.C. 794, which prohibits discrimination on the basis of handicap. Assistance in completing this application is available to any individual. Sign interpreter will be available upon request for the hearing impaired. Please call (708)352-3580 or TTY (708)354-2499 for assistance.

Fill out the form below. Fields with an asterik (*) are required.

Your Information

First Name*
 Middle Initial*
 Last Name*
Address*
 City*
 State*
 Zip Code*
Home Phone Number*
     Cell Phone Number
     Email Address
Position Desired*
 Rate of pay expected

     Date you can start
 
Have you ever applied at Helping Hand before?*
     How did you hear about this job?*
    

Education

High School
   City
   State
   Graduated?
Yes No 		  Degree or specialized courses
College/Univerity
   City
   State
   Graduated?
Yes No 		  Degree or specialized courses
College/Univerity
   City
   State
   Graduated?
Yes No 		  Degree or specialized courses


Employment History
Employer*
 Phone Number*
Address*
 City*
 State*
 Zip Code*
Date Started*
              Pay at Start*
              Date Left
              Pay at Leaving
Supervisor's Name*
   Supervisor's Department*
Your Occupation and Responsibilities*

General
List special abilities that might be of assistance to you in your work at Helping Hand


What do you consider your major strengths and weaknesses?


Briefly, what are your personal and professional goals for the future?


In general, please give any other information you think might be helpful in evaluating your application


Miscellaneous
Please list other data such as professional license/certification, hobbies, interests, other experiences


References
Name
 Phone Number
 Years Known
Address
 City
 State


Name
 Phone Number
 Years Known
Address
 City
 State


Name
 Phone Number
 Years Known
Address
 City
 State


Applicant's Signature
I understand that in order to receive proper consideration for employment:
   1.All items must be answered accurately and in full;
   2.Any misrepresentation shall be considered a cause for non-hire or dismissal;
   3.I must pass a post-offer employment physical and drug screening;
   4.I must pass a background check through the Illinois State Police and Nurse Aide Registry;
   5.I must have a satisfactory driving record if my position requires I drive an agency vehicle;
   6.I grant permission for my current/previous employers to verify and release information to Helping Hand Center or its representatives regarding my employment history, job performance, salary history and work record.

   I certify that answers given herein are true and complete to the best of my knowledge.
   I authorize the investigation of all information contained in this application for employment as may be necessary in making an employment decision.
   During the initial screening of job candidates, Helping Hand relies on the accuracy of information contained in the application form, as well as the accuracy of other information presented during the interview and hiring process. Misrepresentation, falsification, or material omissions in any of this information may result in Helping Hand's exclusion of the individual from further consideration for employment, or, if the person has been hired, disciplinary action, up to and including termination.
   This application for employment shall be considered active for a period of time not to exceed 60 days.

Signature of Applicant*
     Date
By checking this box, I consent to using my typed name above as my digital signature for this application.*