Online Job Application Form

Hope House Application
Applicant Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Restoring Women in Transition

Entry Assessment

Thank you for your interest in the Hope House Program.

To apply for enrollment, the individual must complete this entry assessment form and sign the required documents, acknowledging that she has read and understood the contents. Any false information or deliberate omission will result in the denial of the application.

The mission of Hope House Ministries is to equip women with the tools necessary to become productive community members. Our program uses a biblical perspective to foster personal, spiritual, and emotional growth, aiding in overcoming addiction and other interpersonal challenges. We envision lives transformed, families restored, and individuals emerging as leaders in their homes, churches, and communities. Through God's values and principles, we guide participants in redirecting their lives. Our classes are designed to teach accountability for oneself and others, while allowing God to reshape lives.

2 Corinthians 5:17: “Therefore, if anyone is in Christ, he is a new creation; old things have passed away; behold, all things have become new.” (NKJV)

To be added to our waiting list, please complete and return the entry assessment form. Once received, your application will be prayerfully reviewed, and you will be contacted within 3-5 days, if possible, regarding your acceptance into the program or the waiting list. If accepted and placed on the waiting list, you must call the program director every week to maintain your position.

Failure to call weekly will result in removal from the waiting list.

Please keep your affairs in order, as availability may arise unexpectedly. Once contacted, your bed will be reserved for only 24 hours.

NO EXCEPTIONS
Emergency Contact:

First NameLast Name
Phone Number
Numer to call in case of an emergency
Family Contact:

First NameLast Name
Phone Number
Family contact number
Date of Application

MonthDayYear
Date
In a brief paragraph, explain why you should be accepted into the Hope House Program
Intake Questionaire
Do you need a detox?

YesNo
The HOPE HOUSE Addiction Recovery Program is NOT a detox facility. If you arrive at HOPE HOUSE and realize you need detox, we will not be able to hold your bed for you. However, once your detox is complete and you have a signed release from your physician, HOPE HOUSE will work to find an available place for you.
Do you smoke?

YesNo
How did you hear about Hope House Re-entry Program?
Have you ever been in a long-term Christian discipleship program?

YesNo
Can you work full or part time?

YesNo
Can you read and write?

YesNo
What is your christian background?
Are you willing to spend 9 months in a residential discipleship program?

YesNo
Do you agree to a background check?

YesNo
What has been your addiction?
What has been your drug(s) of choice?
Have you ever been convicted of a sexual offense?

YesNo
Can you pass a 16-panel drug test?

YesNo
Have you ever been a resident at Hope House?

YesNo
Explain why you left or were dismissed:
I, First Name Last Name, understand that the HOPE HOUSE Addiction Recovery Program is a drug- and alcohol-free residential living facility and does not serve as a detoxification facility. Its approach to recovery is holistic with a strong spiritual emphasis. I hereby agree to enter the program with the understanding that if I experience any negative symptoms related to substance abuse, physical abuse, mental trauma, dependence, addiction, or withdrawal, I will be referred to a medical facility for treatment.
Are you on probation/parole?
Charge: Year & County
Charge: Year & County
Charge: Year & County
What else is happening in your life?
Which of the following do you have:*

Government-approved photo IDSocial Security CardBirth CertificateNone of the above
Do you have problems with any of the following health conditions and or challenges? Please circle and or all that apply.
High Blood PressureAsthmaTuberclosisVenereal DiseaseSkin SoresKidney/Bladder ProblemsDiabetesEpilepsy
MigrainesBreathing ProblemsHIVHepatitis AHepatitis BHepatitis CAny STD'sOther
Please explain*
Are you disabled or handicapped in any way?*

YesNo
Please explain*
Mental Illness
Specify diagnosis

I, First Name Last Name, attest that the above information is true and that all medications are prescribed for their labeled purposes and are currently the only medications I am using. Narcotic prescriptions are NOT allowed at Hope House.
NO EXCEPTIONS.
I, First Name Last Name, am fully aware and agree that Hope House is not liable for any injuries sustained during my stay at the facility.

The Hope House program is not responsible for any medical bills, prescriptions, surgical procedures and or any other medical/dental cost incurred during my stay.

I, First Name Last Name, agree to these terms and will assume all financial responsibility for personal injuries, sickness and or other medically related expenses while enrolled in the HOPE HOUSE Program.
Do you have allergies?

YesNo
Please list allergies:
Are you receiving health care?

YesNo
Do you have health insurance?

YesNo
Name of Insurance Carrier:
Do you receive government funds? (SSI, disability, etc.)

YesNo
Please list funds being received:
Are you receiving public assistance?

YesNo
HOPE HOUSE Applicant Authorization to Release Background Information

In connection with my application for residency at HOPE HOUSE, I authorize HOPE HOUSE and, or any agent that contracts with HOPE HOUSE, to solicit background information relative to my criminal records, credit reports, motor vehicle records, workers compensation records, personal references and other public records pertaining to me. If applicable, motor vehicle records or a driving history may be obtained.

I authorize, without any reservation, any person, agency, or other entity contacted by HOPE HOUSE and or any of their agent (s) for purposes of obtaining background report information, to furnish the above-mentioned information.

I release HOPE HOUSE, their respective employees, their agent (s), their employees and all persons, agencies and entities providing information or reports about me from any and all liability arising out of furnishing any such information or reports.
Full Legal Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Other names used:
Social Security:
Current Address: (NO Post Office Boxes are permitted)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous addresses from the last 5 years:
This application has been completed by me, First Name Last Name, without force, duress or coercion, and has been completed of my own free will.
Before being accepted into the Hope House Program, you must carefully review and understand our Policy and Procedures form. By signing this document, you agree to adhere to all rules and guidelines outlined therein.

Policies and Procedures
1. Attend all Hope House events, meet with a guidance counselor, and participate in prayer and devotion.
2. Attend all classes provided by Hope House that pertain to your demographic.
3. Agree to a seven-day "no outside contact" period upon arrival at Hope House, except for communication with Hope House staff.
4. Complete all daily chores in a timely manner and keep your space clean.
5. Follow dress code guidelines and maintain good personal hygiene. (A skirt or dress is required for church attendance.)
6. Demonstrate good behavior toward staff and other houseguests. Disrespectful behavior may result in removal from Hope House at any time. We have a zero-tolerance policy for behavioral issues, and all residents are expected to act with maturity.
7. Complete daily tasks assigned by the House Coordinator. (Tasks will vary daily.)
8. Be punctual and productive with assignments/work, and be grateful for the opportunity to be here.
9. Consistently schedule and attend all appointments, including those for obtaining documentation (e.g., social security card, birth certificate, driver’s license, ID cards).
10. After 30 days at the facility, Hope House will designate one approved person to accompany you off the property. This approval can be revoked at any time.
11. Personal phone usage: You may be required to demonstrate to staff that you need a phone. (This may be assessed after 30 days.)
12. Any items brought to guests will be thoroughly inspected by staff.
13. No smoking or vaping is allowed inside Hope House or on the porch.
14. Agree to random drug tests and house inspections.
15. Attend all probation, parole, and court appointments and pay all fines.
16. Hope House will provide up to 30 days of basic food and hygiene products.
17. Agree to work a minimum of 20 hours per week at Hope House-approved facilities until you are released to seek gainful employment. If you are on Disability or Social Security, you are still required to complete 20 hours per week as long as you are staying at Hope House.
18. Understand that you must actively seek employment within 7 days of arrival.
  Agree to pay $600 per month to Hope House, starting 60 days after arrival.
19. All guests must adhere to a 9 PM curfew—no exceptions.
20. Leaving the Hope House property is permitted only with an approved pass, for work, or for attending church functions.
21. Guests are allowed only during scheduled family days (family days will be scheduled once a month).
22. No romantic relationships are allowed during your stay at Hope House; this is a place for personal healing.
23. Do not borrow money or items of any sort from anyone while participating in the Hope House Program.
For the first 30 days, Hope House will provide transportation. After 30 days, if you still need transportation, it will cost $5 for in-town trips and $10 for trips to the surrounding areas of the Golden Triangle. Any further transportation needs will need to be discussed and approved by the Hope House Board.

If you are evicted for breaking the rules of Hope House, you will forfeit all deposits and rent payments.

I understand that the Hope House is a Christian-based organization.

I am willing to commit up to nine months of inpatient treatment.

Guests MUST have a sincere desire for a True Life Change!

I understand this document can be amended at any time. You will be made aware of any changes made.
Legal Advice

We are not attorneys, and we do not offer legal advice or act as your attorney. If you need legal advice, you must contact an attorney on your own. HOPE HOUSE is not responsible for any legal fees you incur before, during, or after your stay. We can provide transportation from jail.
Acceptance

Acceptance into the Hope House Program is entirely at the discretion of the Director and the Board. We reserve the right to dismiss any participant at any time, with or without cause, for any reason.
By signing this document you agree to uphold the rules & standards listed above.
Applicant Signature

Clear
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Hope House Application

Restoring Women in Transition

Entry Assessment

Intake Questionaire

Legal Advice

Acceptance