Are you 18 years of age or older?
If hired, can you provide proof of citizenship, U.S permanent residency, or authorization to work?
If you answer “YES” To
any of the following questions, provide details under the REMARKS
section below. Answers to the questions below do not automatically
bar you from employment. However your failure to answer any of these
questions or to provide details will significantly delay
determination concerning your qualifications and may bar you from
consideration for employment opportunities.
Has your license/ credential been revoked or suspended in the past?
Were you previously employed by Hope House?
PERSONAL INFORMATION RELEASE
authorize any former or present employer, Military Record Center and
any former school to provide Hope House any and all information
including, but not limited to information as to my character, work
habits, work performance and/or education, thereby releasing and
discharging said institutions from any claims, liabilities or damage.
understand that any offer of employment is contingent upon
satisfactory results of a criminal background check, satisfactory
completion (or results) of a any applicable medical examination (s),
health assessment (s), receipt of satisfactory references, and other
criteria as determined by the program into which I am being hired.
I am applying for a position in which I will have the potential for
regular and substantial contact with children, I understand that my
name will be submitted to the New York State Central Register of
Child Abuse and Maltreatment to determine if I am the subject of an
indicated report of child abuse or maltreatment.
further declare that the answers on this application are true and
correct to the best of my knowledge. I understand that a false
statement, knowingly made, or omission of information may be cause
for a bar or dismissal from employment.
PRIVACY PROTECTION NOTIFICATION
information you are providing on this application is being requested
for the purposes of determining eligibility for employment,
administering employee benefit programs and administering other
authorized employment programs pursuant to local, state or federal
law. Failure to provide the requested information may, in the sole
discretion of Hope House, prevent your initial hiring or result in
the termination of your employment. If hired, the information will be
filed in you personnel folder or separately authorized medical files
maintained by the Director of Human Resources, Hope House, 573 Livingston Avenue, Albany NY 12206
IS AN EQUAL OPPORTUNITY EMPLOYER
New York State Law
prohibits discrimination based on age, race, creed, color, national
origin, religion, sexual orientation, military status, sex,
disability, marital status, prior arrest or conviction record.
If you have questions
regarding reasonable accommodations, contact the Director of Human