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HOPE Center, Inc. Employment Application

Position Applying For: CLASSROOM ASSISTANT

Have you ever been employed under another name?
Yes   No
If Yes, what Name?
Present Address:
Home Phone:
Business Phone:
Are you 18 years of age or older? Yes   No
Social Security Number:

Can you after being hired, verify your legal right to work in the United States?
Yes   No

Can you meet the attendance requirements of this job?
Yes   No

Do you know of any reason why you would not be able to perform the essential function of this job with or without reasonable accomodations?
Yes   No

Name of person to notify in case of emergency:
Home Phone Number
Work Phone Number
If appointed, what date could you report to work?
Would you accept temporary work? Yes   No 
  For how long?

Work Experience

If you have a Resume, please put "See Attached Resume" on parts asking for work experience and schooling.
Salary Range Desired:
Present or Last Job Title:
Date Employed:
Date Separated:
Your Supervisor
Employer - Name of Business:
City: State:     
Contact Person:
Business Telephone Number:
Describe your major duties in detail:
Next Previous Job Title:    
Date Employed:    
Date Separated:    
Your Supervisor:    
Employer - Name of Business:
City: State:     
Contact Person:
Business Telephone Number:
Describe your major duties in detail:

Give three references, not relatives or former employers
Name Address Phone Occupation
Additional References can be attached.

Did you graduate from high school? Yes   No
If not, do you have a GED? Yes   No

Name of College/University:

State Zip:     
Semesters/Quarters Completed:
Major Courses:
Degree and Date Awarded:
Type of Colorado Certification:

Graduate Education - Name:

State: Zip:     
Semester/Quarters Completed:
Major Courses:  
Degree and Date Awarded:
Type of Colorado Certification:

List educational courses completed which pertain to the position for which you are applying:
Are you planning to pursue further studies? Yes   No  

If so, when, where and what courses?

List office machines you can operate:

List membership(s) in Organization, Educational Honors, Correspondence, Courses, etc.
What languages do you speak fluently or understand?

Additional Information
Do you have any objections to our making inquiry of your present employer or any past employer regarding your qualifications?
Yes   No
If yes, please explain:
Have you ever been convicted of a crime?       Yes   No
If yes, please list offense(s) and date(s)      
Note: A conviction will not be an absolute bar to employment

If the job for which you are applying requires you to drive a vehicle, do you possess a valid drivers license?
Yes   No Type
Do you have a vehicle? Yes   No
Applicant must accept the following statements:
I hereby certify that this application contains no willful misrepresentaion or falsification and that the information given by me in this is true and complete to the best of my knowledge and belief. I agree that any misstatement or omission as to material fact may constitute grounds for unfavorable consideration of my application or dismissal.

I hereby understand that to be in compliance with the Colorado Department of Social Services rules and regulations. Hope Center must conduct a criminal Record Check and a Central Registry Inquiry on all new employees.

In the event you do not meet State requirements and are ineligible for employment or if your friendship with Hope Center terminates within a three month period, the cost of the inquiries, as set forth by the State, shall be deducted from your final payroll check, otherwise, the cost will be absorbed by the agency.
A photograph may be required after hire.

Our company is an equal opportunity employer and will consider all applicants for all positions equally without regard to their race, sex, age, color, religion, national origin, veteran status or any disability as provided in the Americans With Disabilities Act.

This application will remain active for one year from date unless renewed by request or applicant.

Upon Employment

I understand that my employment is "at will" and of indefinite duration and that I may terminate employment at any time with or without notice and for any reason, and Hope Center reserves the right to do the same. I have read and/or explained to me and understand the personnel policies of HOPE CENTER, INC., and the State of Colorado as they apply to my position.