Employment Application

  • Date
    MM
    /
    DD
    /
    YYYY
     
  • Name
    First
    Last
     
  • Phone Number
    (###)
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    ###
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  • Email
  • What position are you applying for?
  • What hours can you work?
  • What dates are you available to begin working?

  • Education

  • Name of Graduate School
  • Years completed
  • Degree Received
  • Name of College or University
  • Years Completed
  • Degree Received
  • Do you have your High School Diploma or GED?
    Yes
    No
  • Trainings and Certifications
    Please tell us about any training or certification programs you have completed.

  • Employment History

  • Employer Name 1
  • Employer Address
    Street Address
    Address Line 2
    City
    State / Province / Region
    Zip / Postal Code
    Country
     
  • Employer Phone Number
    (###)
    -
    ###
    -
    ####
     
  • Name of Supervisor
  • Job Title and Work Duties
    Please tell us your job title and describe the duties you performed.
  • Wage
    Please tell us your hourly or salaried wage.
  • Dates of Employment
  • Reason for Leaving
  • Employer Name 2
  • Employer Address
    Street Address
    Address Line 2
    City
    State / Province / Region
    Zip / Postal Code
    Country
     
  • Employer Phone Number
    (###)
    -
    ###
    -
    ####
     
  • Dates of Employment
  • Name of Supervisor
    First
    Last
     
  • Job Title and Work Duties
    Please tell us your job title and describe the duties you performed.
  • Reason for Leaving
  • Wage
    Please tell us your hourly or salaried wage.
  • Employer Name 3
  • Employer Address
    Street Address
    Address Line 2
    City
    State / Province / Region
    Zip / Postal Code
    Country
     
  • Employer Phone Number
    (###)
    -
    ###
    -
    ####
     
  • Dates of Employment
  • Name of Supervisor
    First
    Last
     
  • Job Title and Work Duties
    Please tell us your job title and describe the duties you performed.
  • Wage
    Please tell us your hourly or salaried wage
  • Reason for Leaving
  • Mountain Home Montana may contact the employers listed except:
    Employer 1
    Employer 2
    Employer 3

  • Professional References

    Please list three references that can be contacted by Mountain Home Montana at this time.
  • Reference 1
    First
    Last
     
  • Address
    Street Address
    Address Line 2
    City
    State / Province / Region
    Zip / Postal Code
    Country
     
  • Phone
    (###)
    -
    ###
    -
    ####
     
  • Relationship
  • Reference 2
    First
    Last
     
  • Address
    Street Address
    Address Line 2
    City
    State / Province / Region
    Zip / Postal Code
    Country
     
  • Phone
    (###)
    -
    ###
    -
    ####
     
  • Relationship
  • Reference 3
    First
    Last
     
  • Address
    Street Address
    Address Line 2
    City
    State / Province / Region
    Zip / Postal Code
    Country
     
  • Phone
    (###)
    -
    ###
    -
    ####
     
  • Relationship

  • Travel

    All Mountain Home Montana Case Manager and shift worker positions require travel and sometimes the transport of residents.
  • Do you have a valid Driver's License?
    Yes
    No
  • Is there anything prohibiting you from providing safe transportation of residents in a MHM vehicle?
    Yes
    No
  • Have you received any vehicle citations?
    Yes
    No
  • If yes, please explain

  • Other

  • Volunteer work and memberships
    Please list any memberships in professional or civic organizations or volunteer work that may enhance your job performance.
  • As an adult have you ever been convicted of any crime, other than a minor traffic violation?
    Yes
    No
  • If yes, please explain all of the facts and cicumstances fully so we may evaluate this matter.
  • Are you willing to participate in a Criminal Background Check as part of the screening process?
    Yes
    No

  • Applicant Authorization

    By checking this box the applicant authorizes any employers or references to release any information concerning this application for employment to Mountain Home Montana except as noted above.
  • Applicant Authorization

  • Application Materials

    Thank you for completing the employment application. Please submit a cover letter and resume to the drop box on the employment page or email these materials to info@mountainhomemt.org.