Personal Information

Are you available to work: (Check all that apply)

A conviction will not necessarily bar you from employment. Each conviction will be judged on its own merit with respect to time, circumstances, seriousness, rehabilitation factors, and the essential requirements of the job for which you have applied. If you have been convicted of abuse or a crime, the Department of Human Services will perform an evaluation to determine whether the conviction warrants probibition of employment.

(Proof of U.S. citizenship or immigration status will be required upon employment.)

Employment History

List all of your employers for the past ten (10) years, starting with the most recent. Include military service assignments and volunteer activities. Exclude organization names which indicate race, color, religion, sexual orientation, gender identity or natural origin. Please complete this section even if you include a resume.

Employer One

Employer Two

Employer Three

Employer Four

Employer Five

Employer Six

Employer Seven

Employer Eight

Employer Nine

Employer Ten

Education & Training

  Name Location Years Completed Degree or Diploma Major Minor
High School

Due to the physical requirements of some jobs, applicants will be required to undergo employment entrance examinations after offers of employment have been made. Employment may be conditional on the results of the examinations. In addition, all applicants must pass pre-employment drug tests.

In addition, New Hope employees may be required to submit to a drug and alcohol test under any of the following circumstances: reasonable suspicion, post-accident and rehabilitation. Employees employed in safety-sensitive positions will also be subject to random drug and/or alcohol testing. Testing will be conducted for the following drugs: marijuana, cocaine, opiates, phencyclidine, and amphetamines.

In addition, New Hope is required by law to conduct a child and dependent adult abuse and criminal history record checks on applicants prior to employment and inform applicants of these checks. Your signature below indicates you have been informed of these checks.

If I fail to complete the required physical and entrance examination by the specified time or if the doctor finds I am incapable of performing the essential functions of the job for which I am hired, this will be sufficient cause for cancellation of this application and/or separation from employment with New Hope if I have started working.

I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge and agree that falsified information or omissions may disqualify me from further consideration (eliminates) for employment and may be considered justification for dismissal if discovered at a later date.

Furthermore, if hired, I understand that just as I am free to resign my employment with New Hope, New Hope reserves the right to terminate my employment. I understand that no representative of New Hope has the authority to make any assurance to the contrary. New Hope has the prerogative to assign an employee to different shifts, different job duties, or different areas if the need should arise.

(Type your name here)

Reference Check

In accordance with federal regulations, New Hope is required to check references with special emphasis on verifying that applicants have no history of child or dependent adult abuse. Please sign the statement at the bottom of this page authorizing New Hope to contact your present and former employers.

If you are hired by New Hope, a reference may be sent to your current employer.

Having made application for employment with New Hope and desiring them to be informed as to my previous record and character, I hereby authorize them to investigate my past record and to ascertain any and all information which may concern my record and character, whether same is of record or not, and release my present and past employers, references, and persons whomever from any damage because of furnishing said information.

(Type your name here)


New Hope offers equal opportunity for employment, advancement and continuation of employment to qualified individuals without regard to race, religion sex, age, creed, national origin, marital status, veteran status or disability.

The employer is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, the employer invites applicants to voluntarily provide us with the following information. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those which require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individuals.

Submit Application