Host and Relief Home Application

Host and Relief Home Application

Please read: Because English is the language spoken and understood by the developmentally disabled individuals supported by Restoring Hope, LLC, all persons applying to become direct care support providers with our agency must be able to speak fluent, conversational English, not only to effectively communicate with the individuals in their care, but also for the safety and welfare of our consumers. English language fluency is also required to communicate effectively with support team members and for daily DMH-required documentation.

Please select and read each of the following links before proceeding.

Restoring Hope Informational Guide

Becoming a Contractor with Restoring Hope

Caregiver Requirements

Required Training Information

Please Note

Name*

Please enter (last name, first name.)

Spouse's Name*

Please enter (last name, first name.)

Children in Home*

Please provide the name, age, and gender of any children UNDER 18 years old, living in your home.

Others in Home*

Please provide the name, age, and gender of any other(s) living in your home.

Phone Number*

Phone

Email*

Date of Birth*

SSN*

Please enter your social security number in (###-##-####) format.

How did you hear about RH?*

Position*

Please indicate which position you are applying for, below.

Host Home

Relief Home

HH/Relief Home

House Wheelchair/Handicap Accessibility*

Select

Pets*

Do you have pets in the home? If so, how many and what kind?

Experience*

Do you have experience working with individuals with developmental and intellectual disabilities. If so, please explain. (You may input, No, if that applies to your experience.)

Drivers License*

Please enter the expiration date on your license.

Reliable Transportation*

Select

High School Diploma/GED*

Select

DocuSign

Once you hit Submit, you will receive an email from DocuSign, to complete the remainder of your application.

***Once in DocuSign, and if completing on a Mobile Device, at the top you will find a Mobile Settings button. We advise you switch to this setting, to improve your viewability of the fillable forms.***

Send me a copy of my responses

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