Apply | Family Ties LLC

Employment Application

Thank you for your interest in joining Family Ties Haven LLC. Please complete the application below. Fields marked with an asterisk (*) are required.

Personal Information

First name

Last name

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Birthday

Month

Day

Year

Social Security Number

Location of Service (maintain a reasonable travel distance)

Region 1 (Lake County)

Region 8 (Sullivan, Vigo Counties)

Region 9 (Boone, Hendricks, Morgan Counties)

Region 10 (Marion County)

Region 11 (Hamilton, Hancock, Madison Counties)

Region 14 (Johnson County)

What is your desired pay rate?

How did you hear about us?

Friend

Social Media

Google

Job Board (Indeed, LinkedIn)

Are you a U.S. Citizen or approved to work in the United States?*

Yes

Are you at least 18 years old or older?

Yes

Do you have your own reliable transportation? Note: Our policies prohibit the use of ride sharing as a means of reliable transportation.

Yes

Have you ever applied to Family Ties or Family Ties Haven LLC before?

Yes

Do you have a friend or relative that works for Family Ties or Family Ties Haven LLC?

Yes

Will you consent to a criminal background check, as required to work at Nurturing Hearts LLC? Background check includes drugs, alcohol, previous employment, CPI/CPS, criminal background checks and reference checks.

Yes

Have you ever been convicted of a criminal offense (felony or misdemeanor)?

Yes

Have you ever been investigated by the Department of Child Welfare or Child Protective Services?

Yes

If you answered "Yes" to the any of the questions above, please provide details.

What date are you available to start?

Please share the skills, qualifications, or experiences you possess for the position in which you are applying.

Education

High School Name

Location

Graduation Date

College/University Name

Did you graduate?

Yes

Date of College Graduation

Employment History

Current Employer Name

Job Title

Employer Address

Phone Number

Start Date

End Date

Reason for Leaving

May we contact this employer?

Yes

Employer Name

Job Title

Employer Address

Phone Number

Start Date

End Date

Reason for Leaving

Employer Name

Job Title

Employer Address

Phone Number

Start Date

End Date

Reason for Leaving

Employer Name

Job Title

Employer Address

Phone Number

Start Date

End Date

Reason for Leaving

References

Please provide 3 professional references (not to include family or friends). Failure to provide this information will delay your application review.

Reference No. 1 Full Name

Phone

Reference No. 2 Full Name

Phone

Reference No. 3 Full Name

Phone

All positions at Family Ties Haven LLC require resumes to be on file. Some roles also require proof of high school diploma, college transcript and degree. Please upload the documents you would like to be considered for your candidacy.

I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to hire me, or for discharge should I be hired.

I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for employment. I also authorize you to re- quest and receive such information.

In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added or interpreted at any time, at the company’s sole option and without prior notice to me.

I also acknowledge that my employment may be terminated, or any offer or acceptance of employment with- drawn, at any time, with or without cause, and with or without prior notice at the option of the company or myself.

Signature

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