Decrease Font Size     Increase Font Size

In-house application

Help build meaningful lives by building a meaningful career with Hills & Dales!

Date:

Employee Name

Phone Number:

Street Address:

City:

State:

Zip Code:

Current Position:

Current Employee Category:  FT PT RP Temp

Length of Service in Current Position:

Total Length of Service with Hills and Dales:

Position Applying For:

Describe Your Qualifications:

Have you ever plead "guilty" or "no contest" to, or been convicted of a crime in any state, including deferred judgements?  Yes No

Do you have a record of founded child or dependent adult abuse?  Yes No

If yes to either question, please provide date(s) and details:

List any other names that you have gone by:

By submitting this application, I give Hills & Dales permission to complete a criminal and/or child and dependent adult abuse background check.