The Angel’s Helping Hands Diversion Program Instructor role is designed for dedicated professionals who are committed to guiding and educating at-risk youth toward positive life choices. Instructors play a vital role in delivering structured curriculum, fostering accountability, and supporting personal growth by helping participants develop self-awareness, effective communication, and responsible decision-making skills in a supportive and respectful learning environment.

AHH Diversion Program Instructor Application

Personal Information

First Name ___________ Middle Name__________ Last Name ______________

Date of Birth: ___________________ Social Sec.#: _________________________

Address: _____________________________________________________________

City: ______________________ State: ______________________ Zip Code: ________________

Mobile Phone Number: ____________________ Work Phone Number: _____________________

Email Address: __________________________

Current Driver’s License No.: State:

Ethnicity: ____African American ____Hispanic ____White ____Asian ____Other (please specify) ______________

Emergency Contact Name: Phone Number: Relationship:

High School Name: ___________________________ High School Address: ________________ Years Attended: ______________________________ Graduated? □ Yes □ No

College Name: ______________________________ Years Attended: ____________

Graduated? □ Yes □ No Degree / Major: ________________________

Employment History

Please provide employment information for the past five years, with most recent position held

first.

Employer Name: ____________________________ Employer Address: ____________________

Employer Phone Number: ________________________ Position Held: _____________________

Salary/Wage: ___________________

Supervisor Name: _________________________ Supervisor Phone Number: _______________

Still Employed: □ Yes □ No Reason for Leaving: __________________________

Second most recent position

Employer Name: ____________________________ Employer Address: ____________________

Employer Phone Number: ________________________ Position Held: _____________________

Salary/Wage: ___________________

Supervisor Name: _________________________ Supervisor Phone Number: _______________

Reason for Leaving: __________________________

Third most recent position

Employer Name: ____________________________ Employer Address: ____________________

Employer Phone Number: ________________________ Position Held: _____________________

Salary/Wage: ___________________

Supervisor Name: _________________________ Supervisor Phone Number: _______________

Reason for Leaving: __________________________

Fourth most recent position

Employer Name: ____________________________ Employer Address: ____________________

Employer Phone Number: ________________________ Position Held: _____________________

Salary/Wage: ___________________

Supervisor Name: _________________________ Supervisor Phone Number: _______________

Reason for Leaving: __________________________

Please explain any gaps in employment: ________________________________________________________________________________________________________________________________________________________________

References

Please list three individuals who are very familiar with your professional work and character who may be contacted.

Name: _____________________________ Position: _________________________

Phone Number: ___________________________ Email: _______________________

Relationship: __________________________________

Name: _____________________________ Position: _________________________

Phone Number: ___________________________ Email: _______________________

Relationship: __________________________________

Name: _____________________________ Position: _________________________

Phone Number: ___________________________ Email: _______________________

Relationship: __________________________________

In the field below, please respond to each of the following questions:

1. Why do you want to be a teaching instructor for Angel's Helping Hands Diversion Program?

2. What experience do you have specific to the position you are applying for and how would you use that experience to be a success in Angel's Helping Hands Diversion Program?

3. Describe your greatest accomplishments as an educator.

HONORS AND DISTINCTIONS

List degrees, honors, commendations, elective or appointive offices held, or other distinctions received. __________________________________________________________________

BACKGROUND INFORMATION

• Are you, or have you ever been, listed on a sex offender registry?

□ Yes □ No

• Are you, or have you ever been, listed on a child or dependent adult abuse registry?

□ Yes □ No

• Have you ever been found guilty, accepted a guilty or Alford Plea, or entered a plea of no-contest for any criminal charge?

□ Yes □ No

• Have you ever received a deferred judgment, or in some other way had a guilty plea or conviction removed from your record?

□ Yes □ No

• Have you ever received a deferred judgment, or in some other way had a guilty plea or conviction removed from your record?

□ Yes □ No

• If you answered “yes” to any of the above questions, provide the date, incident, specific charge, city/state in which occurred: __________________________________________________
• Have you ever been asked to resign from a position, or been given the choice of resigning or being terminated from your position?

□ Yes □ No

• Have you ever been the subject of an investigation or other formal/informal proceeding that resulted in the termination of your employment or resignation?

□ Yes □ No

• Have you ever been the subject of an investigation into wrongdoing or other formal/informal proceeding, resulting in disciplinary or criminal action?

□ Yes □ No

• Briefly explain any “yes” response(s):
• Responding "yes" to any of the previous questions is not an automatic bar to employment. The date of the offense and the relationship between the offense or infraction and the position for which you are applying will be considered.
• Are you legally eligible to work in the United States?

□ Yes □ No

• Are you able to perform with or without reasonable accommodation, the essential job functions required of the position?

□ Yes □ No

AGREEMENT (Read carefully before signing or submitting electronically)

By my signature:

• I acknowledge that individuals who provide false, inaccurate, or incomplete information in the application form, in an interview, or any other part of the hiring process or who fail to disclose information requested in the application form, in an interview, or any other part of the hiring process will not be eligible for employment, or, if they are hired, they will be subject to termination.

• I acknowledge that to the fullest extent permitted by state and federal law, Angel's Helping Hands will consider all information concerning an applicant or an employee in making hiring, termination, and other employment-related decisions. The term "all information" includes information of any kind (verbal, written, photographic, videographic, etc.) that is accessible in any medium (print, electronic, etc.) from any source.

• I acknowledge that Angel's Helping Hands will consider public information and other information to which it has lawful access. This may include information that is contained in social networking sites, blogs, and other electronic sites, such as YouTube. If there is information that pertains to me that I believe requires explanation, interpretation, or clarification when it is considered by Angel's Helping Hands, it is my obligation to communicate this information to Angel's Helping Hands.

• I authorize the Angel's Helping Hands to conduct a complete check regarding my background including, but not limited to, criminal record, child and dependent adult abuse registry screening, and sex offender registry. I agree to prepare and sign any other form necessary to complete a criminal background check. I further authorize all government agencies departments, bureaus, or related entities to release any and all information regarding my criminal history, if any. I agree to immediately notify Angel's Helping Hands if I should be convicted of any crime while my application is pending, or during my period of employment, if hired.

• I authorize all current and former employers, teachers, and references to release all information regarding my professional competence, performance, character, and background. I waive any right I may have against any person contacted as a reference concerning this application.

• I acknowledge that information that is relevant to Angel's Helping Hands decisions will be considered regardless of the date on which Angel's Helping Hands obtains the information and regardless of the date on which the information was first published, created, or made accessible to Angel's Helping Hands.

• I understand that this application will be considered active for twelve (12) months from the date filed. I further understand that if I am employed by Angel's Helping Hands, this application and associated documents will become part of my permanent record.

• I understand that this application is not a contract of employment. In accepting the position, if hired, I understand that employment is at will, unless otherwise specified by the Code of Illinois. I acknowledge that Angel's Helping Hands may discharge an at-will employee at any time for any legal reason or no reason at all.

• I agree to submit to both pre-employment random drug and alcohol testing.

By my electronic submission of this form:

• I attest that all the information contained in this application is accurate, complete, and true.

• I am bound by all elements of the agreement section of the application.

• I understand and accept that electronic submission will be considered equivalent to an original handwritten signature on a paper copy of the application.

Name:

Signature:

Date:

• Applicants, and/or their designees, are asked not to contact members of the Board of Directors during this search process.
• Screening for this position will continue until the position is filled.
• In order to be considered for this position, your application materials must include the following:
• Completed application form (including signatures)
• Resume
• Relevant degrees and/or certifications

All application materials should be returned to: Email: [email protected]

Angel's Helping Hands will select for employment qualified applicants for each position without improper discrimination on the basis of race, color, creed, religion, sex, sexual orientation, gender identity, national origin, ethnic background, age, or disability. Persons with disabilities who can perform the essential functions of an assignment with or without reasonable accommodation shall be considered qualified applicants. Angel's Helping Hands shall take affirmative action in the recruitment, appointment, assignment, and advancement of personnel to accomplish the goals of equal employment opportunity.