Meet Our Staff and Board

Online Application

* Indicates required field

Name *

First

Last

Address *

Include city, state, and zip

Phone Number (cell) *

Phone Number (Home) *

Email *

Date of Birth *

without year (ex. 08/03)

Are you 21 years of age or older? *

Yes No

Martial Status *

Number of Children *

if applicable

Name of Spouse *

Age(s) *

Of children

Educational Background *

Occupation *

Place of Employment *

Have you ever been convicted of a crime? *

Yes No

List any previous volenteer experience *

May we contact previous volunteer agencies? *

Yes No

Do you consider yourself a Christian? *

Yes No

If Yes, explain *

Please provide the following information about your church:

Church Name: *

Church Phone Number *

Senior Pastor's Name *

Church Address *

Church Zip Code *

How long have you been involved at the church? *

How did you hear about Heartbeat of Fremont? *

Please explain why you have an interest in this ministry? *

Do you have any experience in the following areas? Unplanned pregnancy, adoption, abortion or counseling - If yes, please explain: *

Do you have any concerns in dealing with these issues? *

Are there areas about our center in which you might feel uncomfortable? *

Have you ever personally known an unwed mother? *

How do you feel about abortion as a solution for an unplanned pregnancy? *

How do you feel about adoption as a solution for an unplanned pregnancy? *

How do you feel about single parenting as a solution for an unplanned pregnancy? *

How do you feel about abortion in cases of rape or incest? *

Do you have any strength that you wish to share with us? *

Do you consider yourself *

When are you available to volunteer? *

e.g., day of the week, daytime, or evening

Listed below are various volunteer opportunities. Please circle any areas which you would prefer to serve: *

Working with Clients Office Receptionist Clerical/office Help Laundry/Sewing Office Cleaning Fund-Raising Events Public Speaking Center Committees Church/Group Liaison Bridges (earn while you learn program) all of the above other

other: *

Would you like to come in on a regular schedule, or be contacted as needed? *

How do you feel about the use of birth control (pills, devices, and condoms) by unmarried girls/women? *

How do you feel about the teaching of abstinence to unmarried men and women? *

Please list two references other than your pastor or family members that we may contact: *

Thank you so much for completing this application. Please return this to our office and we will contact
you to set up an interview. God is at work at Heartbeat Hope Medical and we look forward to sharing His
joy with you.

Heartbeat Hope Medical
Fremont Center
300 S. Front St.
Fremont, OH 43420
419-334-9079

Tiffin Center
380 W. Market St.
Tiffin, Ohio 44883

Fostoria Center
513 Plaza Dr.
Fostoria, Ohio 44830

Submit

Volunteer Application

volunteer_application_1.doc
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Online Application

* Indicates required field

Name *

First

Last

Date of Birth *

without year (ex. 08/03)

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Are you 21 years of age or older? *

Yes No

Available start date *

Desired Salary *

if applicable

Position Applied for *

Are you a citizen of the United States? *

Yes No

If no, are you authorized to work in the U.S.? *

Yes No

Have you ever worked for this company? *

Yes No

If so, when? *

Have you ever been convicted of a crime? *

Yes No

If yes, explain *

Nature of the offense *

Number of convictions *

How Recently *

Sentence(s) *

Types of rehabilitation *

Education:

High School *

Address *

Line 1

Line 2

City

State

Zip Code

Country

From: *

To: *

Did you graduate *

Yes No

College *

From: *

To: *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Did you graduate *

Yes No

Degree: *

Other *

From: *

To: *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Did you graduate? *

Yes No

Degree: *

References:

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Relationship *

Phone Number *

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Relationship *

Phone Number *

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Relationship *

Phone Number *

Previous Employment

Company *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Reason for leaving *

Company *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Reason for leaving *

Phone Number *

Starting salary *

Ending salary *

Best contact *

To: *

From: *

Job title *

Responsibilities *

May we contact your previous supervisor *

Yes No

Phone Number *

Starting salary *

Ending salary *

Best contact *

To: *

From: *

Job title *

Responsibilities *

May we contact your previous supervisor *

Yes No

Military Service:

Branch: *

From: *

To: *

Rank at discharge: *

Type of discharge: *

If other than honorable, please explain: *

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information on my application or interview may result in my release.

Select One *

Please go to our volunteer tab, under "how to help" and fill out our volunteer application.

Thank you so much for completing this application. Please return this and we will contact you to set up an interview. God is at work at Heartbeat Hope Medical and we look forward to sharing His joy with you.

Heartbeat Hope Medical
300 S. Front St.
Fremont, OH 43420
419-334-9079

Submit

Staff:

Executive Director : Marisa Moya
  [email protected]
Marketing Assistant :
  [email protected]
Office Administrator : Jess Barnes
  [email protected]
Tiffin Peer Counselor :
Fremont Peer Counselor : Daira Steiner
  [email protected]
Parenting Coordinator : Micella Rios
  [email protected]
Bookeeper : Barb Collier
  [email protected]
Fremont Receptionist : Beth Garza
  [email protected]
Tiffin Receptionist : Angie Fredritz
  [email protected]
Campus Director : Ruby Santiago
  [email protected]
Nurse Manager : Cindy Brown
  [email protected]
Abortion Recovery Director
[email protected]
iKeep Educator (JJC) : Lori Lauer & Randy Noss
Sexual Risk Avoidance Director : Ruby Santiago

Board Members:

President
Lisa Edris

Vice President
Deb Snyder

Secretary
Melanie Bouy

Treasurer
Jeanine VanDerLaar

Voting Members
Val Floro
Aubrie Decker
Nadine Felton
Grant Decker
Carrie Harmon
Donna DeLeon
Carly Trautwein
Kait Pinkerton
Clay Blymyer

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