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In-house application

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


Employee Name

Phone Number:

Street Address:



Zip Code:

Current Position:

Current Employee Category: FTPTRPTemp

Length of Service in Current Position:

Total Length of Service with Hills and Dales:

Position Applying For:

Specific Location:

Describe Your Qualifications:

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

Do you have a record of founded child or dependent adult abuse? YesNo

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

Do you have a valid driver’s license? YesNo

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.