Dover Children's Home

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Job Application Form

"*" indicates required fields

This application must be completed by all persons seeking employment or internship assignments with Dover Children’s Home. It will be kept on file for a period of one year unless otherwise directed by the applicant. If employed, it will become part of our confidential personnel file. Dover Children’s Home is an Equal Opportunity Employer.

Name*

First Last

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Phone Number*

Cell Phone

Email*

Date Available for Work

MM slash DD slash YYYY

Number of Hours per Week You are Interested in Working

Please enter a number from 0 to 40.

Municipal and state licensing regulations require caregivers to be 21 years of age or older. If applicable, are you at least 21 years of age?

Yes

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?*

Yes

All Dover Children’s Home positions may require driving on the job. Do you have a valid New Hampshire driver’s license?*

Yes

In the last 5 years have you had speeding or stop sign violations, any other traffic violation, DWI or any vehicle related reckless charges or suspensions, any felony driver convictions or reinstatements?*

Yes

If yes, please list here:*

The children placed with Dover Children’s Home need care and supervision at all hours of the day, everyday of the year, including holidays and weekends. Please indicate the type of positions and specific times you are interested in below.

Position(s) Applying for (please check all that apply)*

Family Support Worker

Relief

Youth Support Specialist

Specific Times Available for Work (please check all that apply)*

Anytime

Mornings

Afternoons

Evenings

Weekends

Mon-Fri

Please Upload Current Resume*

Drop files here or

Max. file size: 128 MB, Max. files: 2.

What other work/volunteer experience, educational experiences, special skills or hobbies qualify you for the position for which you are now applying? (Be specific as to dates, amount of time worked, and location/address.)

References

Please list 2 non-relatives and 1 parent or close family member who know your character, experience, and abilities:

Name*

Address

Phone

Years Known

Relationship

Name*

Address

Phone

Years Known

Relationship

Name*

Address

Phone

Years Known

Relationship

If any of the above employers or personal references know you by a name other than the one listed on this application, please note it here:

Have you worked for Dover Children’s Home before?*

Yes

If yes, please provide dates of employment and position held:*

Have you ever been convicted of any crime, including simple assault, sexual assault or other sex-related crime, or child abuse/neglect offenses?*

Yes

If yes, please provide detailed information:*

Supplemental Information For Direct Care Positions

1. What are your thoughts about establishing routines, limits and discipline while working with children?

2. What experience have you had that might help you to better understand and work with the residents at Dover Children’s Home (DCH)?

3. Please use the following information to write a brief summary of a client’s behavior. Please write the summary as if it will be shared with the child, the child’s parent, and the child’s therapist, with the intent of communicating the client’s current functioning.

Client is a 15 year old female
Frequently refuses to follow staff directives
Maintains above average grades in school
Consistently skips multiple classes each week
Calls DCH for support while on home visits due to high conflict with parent during visit
Keeps her room clean and attends well to personal hygiene
Suspected of smoking marijuana, but has not been caught doing so

Certificate of Applicant*

I agree to the following

I hereby certify that all information made on or in connection with my application for employment with Dover Children’s Home is true and complete to the best of my knowledge and that I have not knowingly withheld or falsified any fact or circumstance. I understand that any misrepresentation or concealment of material fact will be sufficient ground for rejection of this application or removal from employment.

I hereby authorize my present and previous employers to release to Dover Children’s Home an evaluation regarding my employment record with them and release said employers from any damage or claim for furnishing said information.

I hereby authorize the persons listed herein as personal references to furnish Dover Children’s Home any information they may have regarding my character and release said persons from any damage or claim for furnishing said information.

I hereby authorize my present and previous schools and colleges to release to Dover Children’s Home my transcripts and verification of degrees earned and release said educational institutions from any damage or claim for furnishing said information.

Furthermore, I authorize the use of reproduced copies of this certification to be sufficient proof for the release of the above requested evaluations, references and records.

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Address

Dover Children’s Home
207 Locust Street
Dover, NH 03820
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EIN 02-0223323

Contact Us

Phone: 603-742-4289
Fax: 603-742-2057

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Dover Children's Home

WE ARE LOOKING FOR A NEW KITCHEN MANAGER! APPLY HERE

Job Application Form

References

Supplemental Information For Direct Care Positions

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