“Bello Machre provides an incredible service and exceptional care. It’s a very inspiring place to work.”
–Michelle Bathras, Vice President and COO

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Applicant Work Preferences

* Indicates Required Field

	I am interested in applying for the following positions: (click on the position(s) that best suit your interest) (Please select at least one) Direct Care Support Staff Residential and Support Services opportunities available Full and part-time schedules available Morning, afternoon, evening, overnight and weekend hours available Responsibilities include providing personal care and support to the people living in the home, assisting them with activities in the home and in the community, attending doctor's appointments, going grocery shopping, and cleaning/straightening the home Some level of paperwork is required, such as writing transition notes (documentation of what happened during the shift) and documenting any medications given
	Family Living Director (FLD) Traditionally known as "House Manager" Full-time, managerial positions Schedule is usually Monday through Friday - 50 hours per week In most homes we offer apartment style living accommodations in a private residential home in the community. No rent, no mortgage! Utilities, basic phone and basic cable are company paid The primary responsibility is to provide a family style living environment for the adults living in the home, helping them to be as independent as possible and to be as engaged in the community as they wish Additional responsibilities include providing personal care and support to the people living in the home, assisting them with activities in the home and in the community, assisting with goal planning, supervising support staff, managing home finances, scheduling/attending doctor's appointments, maintaining a neat/clean home, grocery shopping, and maintaining appropriate paperwork for the home
	Administrative Provides management and administrative support in the areas of finance, human resources, development, maintenance, residential, and support services
I am able to work the following schedules: (Please select at least one)
	Full Time
	Part Time
(Please select at least one)
	Every Weekend
	Every Other Weekend
	Weekdays
(Please select at least one)
	Mornings
	Afternoons
	Evenings
	Overnights
I am willing to drive to the following work locations in Anne Arundel County: (Please select at least one)
	Glen Burnie
	Pasadena
	Linthicum
	Severna Park
	Arnold
	Annapolis
	Millersville
	Gambrills
	Odenlon
	Severn
	All of the above

Application For Employment

Position(s) Applied For
Date of Application
How Did You Learn About Us?	Career Builder Capital/Gazette The Baltimore Sun Employment Guide Other (please specify) Referred by (please specify)

Last Name *
First Name *
Middle Name
Address *
City *
State *
Zip Code *
Telephone Number(s) *
Cell Telephone Number(s)
Email

* All questions required

Are you 18 years of age or older?

Yes No

For House Manager Candidates only: Are you 21 years of age or older?

Yes No

Have you ever filed an application with us before?

Yes No

If yes, give date (mm/yy)

Have you ever been employed with us before?

Yes No

If yes, give date (mm/yy)

Are you currently employed?

Yes No

May we contact your present employer?

Yes No

Are you prevented from lawfully becoming employed in
this country because of Visa or Immigration Status?
Proof of citizenship or immigration status will be required upon employment.

Yes No

On what date would you
be available to begin work? (mm/dd/yy)

/ /

Do you have a valid Maryland driver's license?

Yes No

If no, explain

Have you ever been convicted of a reckless driving or of an alcohol or drug related traffic offense, or has your drivers license been suspended or revoked?

Yes No

If yes, explain

Have you been convicted of a crime, excluding expunged records?
Conviction will not necessarily disqualify an applicant from employment.

Yes No

If yes, explain

Education

	Name of School City & State	Course of Study	Did you Graduate?	Diploma or Degree
High School
Undergraduate College
Graduate Professional
Other (please specify)

Additional Information

Please check any additional training completed
		Date Completed (mm/yy)
	CPR/First Aid	/
	Certified Medication Training	/
	OSHA & Bloodborne Pathogens	/
	Choking Prevention & Dysphasia Diets	/
	Behavioral Principals & Strategies	/
	Certified Nursing Assistant (CNA)	/
	IP Training	/
	Other (please specify)
	If medication certified, has certification ever been revoked or suspended?
	If certified nursing assistant, has certification ever been suspended or revoked?

Other Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experience

State any additional information you feel may be helpful to us in considering your application including explanation of any gaps in employment

Employment Experience

Start with your present or last job and list all employment. Attach separate sheets if necessary. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities, or other protected status.

Employer *

Address *

Dates Employed (mm/yy) *

From: /

To: /

Responsibilities/Work Performed *

Supervisor Name & Title *

May we contact for a reference? *

Yes No

Job Title *

Supervisor Phone # *

Reason For Leaving *

Hourly Rate/Salary *

Start

Final

Employer

Address

Dates Employed (mm/yy)

From: /

To: /

Responsibilities/Work Performed

Supervisor Name & Title

May we contact for a reference?

Yes No

Job Title

Supervisor Phone #

Reason For Leaving

Hourly Rate/Salary

Start

Final

Employer

Address

Dates Employed (mm/yy)

From: /

To: /

Responsibilities/Work Performed

Supervisor Name & Title

May we contact for a reference?

Yes No

Job Title

Supervisor Phone #

Reason For Leaving

Hourly Rate/Salary

Start

Final

Employer

Address

Dates Employed (mm/yy)

From: /

To: /

Responsibilities/Work Performed

Supervisor Name & Title

May we contact for a reference?

Yes No

Job Title

Supervisor Phone #

Reason For Leaving

Hourly Rate/Salary

Start

Final

Employer

Address

Dates Employed (mm/yy)

From: /

To: /

Responsibilities/Work Performed

Supervisor Name & Title

May we contact for a reference?

Yes No

Job Title

Supervisor Phone #

Reason For Leaving

Hourly Rate/Salary

Start

Final

You may attach a resume to your application. Click browse to locate it on your computer and it will be sent with your application

Initial each field
	* I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements and/or omissions on this application shall be grounds for dismissal.
	* I authorize investigation of all statements contained herein. I authorize the employers listed above to verify any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise. I release all parties from all liability for any damage that may result from furnishing same to Bello Machre, Inc.
	* I authorize Bello Machre, Inc., or its authorized agent to obtain any information relating to my activities from schools, residential management agencies, employers, military services, government agencies, criminal justice agencies, motor vehicle agencies, or other sources of information. This information may include, but is not limited to, my academic achievements, residential history, previous job performance, attendance and other disciplinary actions, employment history, motor vehicle driving history, and criminal history record. I understand that the purpose of collecting this information is to assist in determining my eligibility for employment.
	* I understand that I will be asked to undergo a pre-employment screening and evaluation, under the direction of Bello Machre, Inc.'s psychological consultant and that this evaluation may be considered, among other factors in determining my potential employment at Bello Machre. I agree to release, hold harmless and forever discharge Bello Machre, Inc., and its agents, servants, successors and all the psychological consultants from any and all claims, actions, causes of actions, demands, rights, damages, costs, loss of association or partnerships of and from any and all claims which I may have as a result of or growing out, of the psychological screening, evaluation and its use in consideration of my being chosen from employment and/or research.
	* I authorize Bello Machre, Inc., to contact other human service providers and agencies to inquire as to whether I have ever worked as a caregiver for those providers and agencies. I agree to hold harmless and waive any claims against Bello Machre, Inc., for making any such inquiry and to hold harmless and waive any claims against all providers and agencies who respond to such inquires.