Admission Forms Hosea's House Ministries Entry FormPlease enable JavaScript in your browser to complete this form.Name *FirstLastDate *Why are you asking to be accepted into Hosea's House? *Do you need to try to break a drug/alcohol/substance abuse addiction? *YesNoDo you wan to learn how to live a life free of controlling substances? *YesNoHave you ever been arrested or charged with a felony? *YesNoIf yes, please explainDo you have a probation officer? *YesNoAre you currently using illegal drugs *YesNoDo you smoke cigarettes or use tobacco? *YesNoAre you willing to quit smoking? *YesNoAre you currently using prescription drugs in an illegal way? *YesNoDo you have a problem submitting to authority? *YesNoAre you willing to submit to the authority of ALL staff of Hosea's House? *YesNoDo you understand that Hosea's House is a Christian discipleship program and utilizes Christian based principles? *YesNoDo you understand that if you smuggle any drugs/pornography/alcohol/ anti-Christ items/unauthorized person in the house you will be automatically dismissed? *I UnderstandAre you willing to only be in contact with the people the staff approve? *YesNoAre you willing to adhere to modest dress attire? *YesNoDo you understand that you are required to go to Church (only Churches approved by Hosea's House) on Sunday and participate in weekly Bible study? *I UnderstandHave you ever been abused either Physically/ Emotionally/Financially/ Verbally? *PhysicallyPhysicallyEmotionalFinanciallyVerballyHave you ever filed an Emergency Protective Order? *YesNoIf yes, please explain.Have you ever been involved with Child Protective Services? *YesNoIf yes, please explainDo you understand we reserve the right to do random drug testing ? *I UnderstandDo you understand that we reserve the right to check your room & belongings at our discretion in the presence of two Hosea's House staff members? *I UnderstandHave you ever been raped? *YesNoIf yes, have you ever recieved therapy?YesNoHave you ever had an abortion? *YesNo If yes, have you ever received therapy?YesNoHas anyone ever threatened you or your child/children in ANY way? *YesNoAre you a Christian? *YesNo Are you Born-Again? *YesNoIf no, what is your religious affiliation?What recent spiritual changes have you had in your life (if any)?Have you supported yourself in the last year? *YesNoDo you owe money to anyone? *YesNoIf yes, how do you plan to repay them?What areas of your life do you need help? *Have you ever been involved in a homosexual relationship? *YesNoDo you understand that Hosea's House does NOT support homosexuality? *I UnderstandHave you or your child/children ever been involved in a sex crime? *YesNoIf yes, please explainWhat is your current job status? *EmployedUnemployedStudentRetiredDo you understand that Hosea's House requires each resident to either work, volunteer or go to school? *I UnderstandHobbies *What would you like to learn if someone were willing to teach you? *What is your trade or profession? *How many different jobs have you held in the last year? *What kind of specific job training have you had even if you never used it?What kind of job or trade would you like to learn? *Did you graduate High School? *YesNoIf no, did you earn your GED?YesNoIf yes, When?If Month is unknown, use your best guessList any prescription medications you have taken in the last yearApplications must be accompanied with a copy of picture ID and Social security card. A background check is required for all potential resident's. We understand that some potential resident's may have a background history. We will review each case and discuss with the potential resident at the time of interview. After the 60 day time period, Hosea's House requires each resident to pay $30.00 a week for house expenses. There is also a cost of $50.00 a week for food unless food stamps cover this cost or a hardship request has been granted by the Board of Directors. *By signing, I agree that I have read and agree to the above.Date *Hosea's House StaffDateSubmit Pages: 1 2 3