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Empowering Individuals
NHR Job Application
Please provide the following information:
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)
Accounting Generalist
Direct Support Professional-Industrial Services
Residential Services - Team Lead
Residential Services - Manager
Industrial Services: Business Development Specialist
Employment Consultant
Industrial Services: Material Handler
Controller
Friendly Bean Manager
Name
*
Name
First Name
Last Name
Address
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Home Phone
*
Home Phone
(###)
###
####
Cell Phone
Cell Phone
(###)
###
####
Okay to receive texts?
Yes
No
Email Address
*
Do you have a valid driver's license?
*
Yes
No
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
No
Are you age 18 or older?
*
Yes
No
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
LinkedIn
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
Employer's Phone
(###)
###
####
Start Date
Start Date
MM
DD
YYYY
End Date
End Date
MM
DD
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.
*
Thank you!