HCC Application Form

Employment/Volunteer Application
Our Mission

Providing a continuum of care to improve the lives of people living with HIV/AIDS

Our Vision

Hope and life for the HIV/AIDS Community

Our Philosophy

Respect, Partnership, Quality, Dignity, Compassion, Independence
Employment/Volunteer Process Guide

(Please read and consider all of this information prior to completing an application)

Thanks you for your interest in employment and volunteer opportunities with Hope Care Center. In an effort to make the application process as simple as possible, please review the key points below in order to help you better understand our employment and volunteer process.

Age

Employees at Hope Care Center must meet the minimum age requirement of 18, with the exception of a few positions that require a candidate to be at least 16 years of age. A high school diploma or equivalent is required for most positions. Volunteers at Hope Care Center must be at least 18 years of age.

Working Conditions/Background checks/Drug Screens

Hope Care Center is open 24 hours per day, seven days per week, including holidays. We complete background checks on potential candidates for employment and volunteer positions. These checks include, but are not limited to:crimial background checks and checks to ensure candidates have not been excluded from participation in Federal or State funded programs. In addition, all candidates extended offers of employment (or individuals who have been approved as volunteers) will be required to undergo pre-placement drug screens within 48 hours of accdeptance offers.

Selection

-Applicants must meet minimum requirements to be considered for positions for which they apply.

-Applicants who best meet the requirements for available positions will be contacted for interviews.

-The applicantions of candidates who meet the minimum requirements of the positions for which they apply, but are not called for interviews will be kept on file for six months.

-Applicant's work history, education, and job interests will be reviewed at the first interview. Benefits and pay may also be discussed.

-Applicants who have participated in a first interview may be called for a second interview OR receive a regret letter indicating that another applicant has been selected and that the application has been placed on file for future review.

Notification

Due to the number of applications received, we are only able to reply to those who receive an interview. Hope Care Center makes every effort to notify each applicant as to the status of his or her application after the first interview.
Personal Information:
Full Name*

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail
Birth Date*

MonthDayYear
Are You a U.S. Citizen?

YesNo
Social Security Number
Type of Employment Desired:
Position Applying For
Date You Can Start

MonthDayYear
Type of employment desired:

Full-timePart-timeTemporary/PRN
Shifts Available:

DaysEveningsNights
Salary Desired
Have you ever been employed by Hope Care Center before?

YesNo
If yes, complete the following:
Dates of previous employment
Department worked in
Reason for leaving
Educational Background:
High School
Name of High School Attended, City, State
Number of Years Attended
Graduated?

Yes
GED

YesNo
College / Graduate School
Name of College/University Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
College
Area of Study/Degree
Graduate School
Business College or Vocational School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
If currently enrolled in an educational program, explain
Personal Data:
Select all that are true for you

I am under the age of 18I have restrictions or limitations that prevent me from performing the job's minimum physical requirementsI have been charged with, pled guilty to, or been convicted of a misdemeanorI have been charged with, pled guilty to, or been convicted of a felonyI have participated in a first offender, deferred adjudication, or other program or arrangement where judgment or conviction has been withheldI have criminal charges currently pending against meI have been excluded from participation in a Federal government health care program including Medicare or MedicaidI currently have relatives employed by Hope Care CenterI am not able to submit proof of US citizenship or lawful alien status that permits me to work in the US
If you selected any of the above, explain here:
Skills/Qualifications:
Specialized Nursing Home/Hospital/Medical Experience

CNACMTChaplainCounselorFood SeriveHousekeepingICD-9 CodingLPNMedical Records ClerkOccupational TherapistPhysical TherapistSpeech TherapistRestorative AideRNSafety & Security OfficerSocial WorkerHIV/AIDSOther
Specialized Office Experience

AccountingBookkeepingBusiness OfficeCalculatorData EntryMedical TerminologyPayrollComputer Software ProgramsRecord FilingReceptionist
Additional Work Experience

ElectricianGeneral MaintenanceGroundskeepingHVACLaundryPainter/PlasterPlumberTransportation/CDLOther
List any other specialized skills not covered above
Registration Licensure: check all that apply to you

I am licensed in Missouri or have applied for Missouri LicenseMy license has been suspended, revoked or terminatedI have a professional registration, licensure, or certification action(s) currently pendingMy license has been placed on probationI have informally resolved a recommended or potntial adverse action involoving professional licensure, registration or certificationI have been a defendant in a civil legal action involving my professional competence
List any relevant certifications, professional licenses or registration including the issuing authority, license # & expiration date.
If you checked any of the above, please explain:
Employment History

Please begin with your current or most recent employer and follow with former places of employment even if resume is attached.
Current or Most Recent Employer
Address
Supervisor Name / Phone Number
Position/Job Title
Salary
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
Date
Previous Employment:
Previous Employer
Name of Previous Employer
Address
Supervisor name / phone number
Position/Job Title
Nature of work performed & responsibilities
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
Previous Employer
Name of Previous Employer
Position
Salary
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
References:

Please list three professional references other than employers or relatives
Reference 1
Name of Reference
Relationship
Years Acquainted
Phone
Email
Reference 2
Name of Reference
Relationship
Years Acquainted
Phone
Email
Reference 3
Name of Reference
Relationship
Years Acquainted
Phone
Email
Cover Letter & Resume (Optional):
Cover Letter

Upload a File

Cancelof
Resume

Upload a File

Cancelof
Send Application:
By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employement may be terminated at any time.

I authorize the companies, persons or organizations named to give any information regarding my employment, together with any inforatmion they may have regarding me, whether or not it is in their records. I hereby release said companies, persons. or organizations from any liability or damage for issuing this information.

I understand that any offer of employment is contingent upon obtaining satisfactory responess to reference inquiries, background checks and results of a post-offer, pre-placement drug screen and employee health assessment.

In consideration of my employment, I agree to conform to Hope Care Center's rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. If employed, I understand that I may be required to submit to periodic blood tests, urinalysis, or other drug and alcohol screening as a condition of continued employment. Refusal to consent may result in disciplinary action, up to and including termination. In addoition, I may be subject to periodic bacground checks as required by HCC's Corporate Compliance Program as well as other appropriate laws and governing bodies.

I understand that completion of this application for employment is not a contract for employment and that if employed by HCC, employment and compensation may be terminated with our without cause at anytime at the option of HCC or myself.

By clicking the submit button below, I have read and fully understand the above information.
Should be Empty:

Employment/Volunteer Application

Personal Information:

Type of Employment Desired:

Educational Background:

Personal Data:

Skills/Qualifications:

Employment History

Previous Employment:

References:

Cover Letter & Resume (Optional):

Send Application: