HOME Program Field Staff Application

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About Us
Our Services
75th Anniversary
Events
Volunteer
- Individual Volunteering
- Group Volunteering

Ready to Join the HOME Team?

Personal Information

Full First Name*

Middle Initial*

Last Name*

In order to allow us to adequately perform a background check and verify your employment and education history, please state any other name(s) under which you have been employed or attended school:

Alternate Name 1

Alternate Name 2

Address*

Full Street Address with Apt # if applicable

City*

State*

Zip Code*

Home Phone*

Cell Phone

Email Address*

How did you hear about our employment opportunities?

Can you work legally in the United States?*Yes

If it is NOT legal for you to work in the US, we can not process your application for employment.

Skills and Availability

Position(s) applying for*

Date Available to Start*

Are you currently employed?*YesNo

May we contact your employer?*YesNo

Do you have a valid driver’s license?*YesNo

Do you have a vehicle you can drive for work?*YesNo

Which cities would you prefer to work in?*

Work Experience

Please list your current and prior work experience.

Job Title*

From (MM/YY)*

To (MM/YY)*

Salary*

per*

Reason for Leaving*

Employer’s Name and Address*

May We Contact This Employer?*YesNo

Supervisor’s Name and Phone Number*

May We Contact This Supervisor?*YesNo

Second Previous Employer

Job Title

From (MM/YY)

To (MM/YY)

Salary

per

Reason for Leaving

Employer’s Name and Address

May We Contact This Employer?YesNo

Supervisor’s Name and Phone Number

May We Contact This Supervisor?YesNo

Other Qualifications

Please list any other related work experience, training or volunteer experience:

Education History & Information

School Name*

City*

State*

Did you Graduate from this School?*YesNo

References

Please list 2-3 persons not related to you whom you have known at least one year.

Name*

Relationship*

Daytime Phone*

Alternate Phone

Email Address*

Second Reference

Name*

Relationship*

Daytime Phone*

Alternate Phone

Email Address*

Third Reference

Name

Relationship

Daytime Phone

Alternate Phone

Email Address

Upload Your Resume (Optional)

Please upload a copy of your resume in .pdf, .doc, .docx or .txt format.
Maximum file size is 20MB.

File Upload (pdf, doc, docx, or txt) – 20MB max.

Applicant Certification

I authorize investigation of all statements contained in this application.

I understand that misrepresentation or omission of facts called for is consideration for dismissal.

By using the electronic signature field and dating this application below, it constitutes as a legal signature.

Your Signature*

Application Date*

You may also download a fillable application below, complete it on your computer, or print it to complete by hand.
Return it by email to HOME@seniorcommunity.org or mail it to the address listed on the form.

Download Application Form