Employment Application — Halia Home & Community Services

Position & Availability

Tell us what role you're applying for and when you can work.

Position applying for

Earliest start date

Employment type desired

Full-time Part-time Per diem / PRN

Shifts you are available to work

Day Evening Overnight Weekends

Contact Information

How we can reach you about your application.

First name

Last name

Phone

Street address

City

State / ZIP

Eligibility

These questions confirm baseline requirements for employment.

Experience & Certifications

Certifications are helpful but not required for all roles — training may be provided.

Current certifications (check all that apply)

Highest level of education

Years of experience in IDD / human services

Why are you interested in working with individuals with disabilities?

Work History

Please list your two most recent employers. If you attach a résumé below, brief entries are fine.

Most recent employer

Employer name

Your job title

Dates employed

Reason for leaving (if applicable)

May we contact this employer?

Yes No Contact me first

Previous employer

Employer name

Your job title

Dates employed

Reason for leaving

References

Optional — two professional references. You may also provide these later.

Reference 1 — name & relationship

Reference 1 — phone or email

Reference 2 — name & relationship

Reference 2 — phone or email

Résumé

Optional, but encouraged.

Attach your résumé (PDF or Word)

Your file is emailed directly to our hiring team along with your application.

Certification I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that false or misleading information may disqualify me from consideration or result in dismissal if discovered after hire, and that this application does not constitute a contract of employment.

After submitting, you'll see a confirmation page. Our hiring team reviews every application and will contact you if there's a fit.