Employment Application - Hope in The Mountains

Hope in The Mountains

(606) 874-0240
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- - - SITEMAP
- - - PROGRAM
      
      Intake & Orientation
      High-Intensity Residential
      Low-Intensity Residential
      Transitional Living Program
      Outpatient Services
  - - ABOUT
      
      About Hope in the Mountains
  - - ADMISSIONS
      
      Admissions
      Family Info
      Insurance
      Informational Videos
  - - CONTACT
      
      Contact
      hitm@hopeinthemountains.org
      606 874 0240
      105 Trimble Chapel Square Prestonsburg, Kentucky 41653

EMPLOYMENT APPLICATION

Applicant Information
Education
References
Previous Employment
Military Service

20%

Applicant Information

Last Name: *

First Name: *

M.I.:

Street Address: *

Apartment/Unit #:

City: *

State: *

Zip Code: *

Phone Number: *

Email Address *

Date Available: *

Desired Salary:

Position Applied for:

Are you a citizen of the United States?: *

Yes No

If no, are you authorized to work in the U.S.?:

Yes No

Have you ever been convicted of a felony?: *

Yes No

Are you willing to work, check all that apply: *

Days Evenings Nights Weekends

40%

Education

High School Name:

Address:

From:

To:

Did you graduate?:

Yes No

College:

Address:

From:

To:

Did you graduate?:

Yes No

Degree:

Other:

Address:

From:

To:

Did you graduate?:

Yes No

Degree:

60%

References

Please list three professional references.

Full Name: *

Relationship: *

Company: *

Phone Number: *

Address

Full Name: *

Relationship: *

Company: *

Phone Number: *

Address:

Full Name: *

Relationship: *

Company: *

Phone Number: *

Address:

80%

Previous Employment

Company:

Phone Number:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes No

Company:

Phone Number:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes No

Company:

Phone Number:

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes No

100%

Military Service

Branch:

From:

To:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature: *

Date: *

Contact us to speak with a team member and learn more about our admissions process.

606 874 0240
hitm@hopeinthemountains.org

PROGRAM

Intake & Orientation

High Intensity Residential

Low-Intensity Residential

Transitional Living Program

Outpatient Services

ABOUT

About Hope in the Mountains

HOPE IN THE MOUNTAINS

We chose our name, “Hope in the Mountains,” to reflect our mission. To bring hope to communities and families affected by the scourge of addiction. We do this by helping women with addictions like you on a journey to a lifetime of recovery. We’ll help you reclaim positive personal values and your sense of dignity and self-respect. Hope In The Mountains is a licensed AODE provider through Kentucky. Our facility is also a Licensed Behavioral Health Services Organization.