I am interested in: *

Direct Support Professional-Community Connections

Direct Support Professional-Residential Services (Full Time & Part Time)

Direct Support Professional-Residential Services (Part Time-Weekends only)

Rest Area Attendant

Industrial Services Warehouse Material Handler

Production Worker

Pre-ETS Career Coach (Part-time)

Residential Services Manager

Employment Consultant

Name *

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone *

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Okay to receive texts?

Yes

Email Address *

Do you have a valid driver's license? *

Yes

Available to work? *

Full Time

Part Time

Weekends

Shifts available to work? *

1st Shift

2nd Shift

3rd Shift

Have you been convicted of a felony within the last ten years? *

Yes

Are you age 18 or older? *

Yes

How did you learn of the job opening? *

How did you learn of the job opening?

Newspaper

Website

Social Media

Ivy Tech

Batesville Online

Social Media Post

Indeed

NHR Employee (Please list employee name below for incentive program)

NHR Employee Referral Name:

Education *

Highest Level of Education Completed

Less than high school

High school diploma or equivalent

Some college, no degree

Associate’s Degree

Bachelor’s Degree

Master’s Degree

Doctoral or Professional Degree

Employment History *

Most Recent Employer Name

City/State

Immediate Supervisor

Employer's Phone

(###)

###

####

Start Date

YYYY

End Date

YYYY

Reason for leaving

Discharged

Voluntary Resignation

Involuntary Resignation

Still Employed

Job Title

Type of work preformed

How many years experience do you have working with individuals with intellectual and developmental disabilities? In what capacity? *

Describe how you handle on the job stress. *

NHR Job Application

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