Fill - Free fillable EMPLOYMENT APPLICATION PDF form

EMPLOYMENT APPLICATION

Check One (“Ministry”)

Texas Baptist Childrens Home STARRY

Children At Heart Ministries

Miracle Farm Gracewood

Instructions: Complete all pages. Complete online or print and complete. Print clearly; incomplete or illegible applications

will not be processed. Please note “Not applicable” if not answering question.

POSITION APPLIED FOR: ________________________________ TODAY’S DATE: __________________

LEGAL NAME

CURRENT ADDRESS

PRIOR ADDRESS

EMAIL ADDRESS Salary Desired:

HOME PHONE: __________________ WORK PHONE: ________

______ CELL PHONE: ____________

AVAILABILITY

Date you can begin work: _____________________________________________________________________________

I can work the following:

(check all that apply)

Weekdays Weekends Evenings Nights

24-hour live-in Overtime Shift Other _____________

EMPLOYMENT INFORMATION

Yes No Are you 18 years or older? (Texas requires employee to be at least 21 for some licensed program positions)

Yes No Have you worked for this Ministry previously? If yes, when and where __________________

_____________________________________________________________________________

Yes No Have you submitted an application to this Ministry before? If yes, when __________________

List Friends or relatives working for this employer: _________________________________________________

Where specifically did you hear about this position?_________________________________________________

PROFESSIONAL LICENSES AND CERTIFICATIONS

Yes No Do you hold a professional license for the position for which you are applying:

Name of license/certification ___________________________________________________________

License/certification number ______________________________ Issuing State _____________

Yes No Has your license/certification ever been revoked or suspended?____________________

If yes, state the reason(s), date of revocation or suspension and date of reinstatement________________

___________________________________________________________________________________

HR 100 (02/09) ~ 1 ~

STREET

CITY

STATE

ZIP

STREET

CITY

STATE

ZIP

FIRST

MIDDLE

LAST

(as it appears on

Social Security card)

PREFERED NAME

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Reset Form

EMPLOYMENT APPLICATION

EDUCATION

Please mark the highest grade completed 7 8 9 10 11 12 13 14 15 16+

Did you graduate under a different last name? Yes No

If yes, list the last name you graduated with

EDUCATION NAME/ADDRESS, CITY & STATE

COMPLETED

DEGREE/MAJOR/GRADUATION DATE

High School

Under Graduate

College

Graduate &

Professional School

Technical/Trade

Other training

JOB-RELATED SKILLS

IF REQUIRED FOR JOB, INDICATE ANY FOREIGN LANGUAGES YOU SPEAK, READ AND WRITE

FLUENT GOOD FAIR

SPEAK

READ

WRITE

DESCRIBE ANY SPECIALIZED TRAINING, APPRENTICESHIP, SKILLS & EXTRA-CURRICULAR ACTIVITIES

__________________________________________________________________________________________________

STATE ANY ADDITIONAL INFORMATION THAT MAY BE HELPFUL IN CONSIDERING YOUR APPLICATIONS

_____________________________________________________________________________________________________________

_________________________________________________________________________________________________

PERSONAL REFERENCES

Please list three individuals that have known you well for at least one year. Do not include names of supervisors listed in this

application or immediate family members.

TYPE OF

REFERENCE

PERSONAL PERSONAL EXTENDED FAMILY

NAME

ADDRESS

CITY

STATE, ZIP

PHONE

HR 100 (02/09) ~ 2 ~

Yes No

EMPLOYMENT APPLICATION

EMPLOYMENT HISTORY

PLEASE NOTE: Your application may not be considered unless every question in this section is answered. Since we will

make every effort to contact previous employers, the correct telephone numbers of past employers are critical. List your

most recent position first, use additional sheets if necessary. Explain any periods of unemployment or time periods between

times employed.

MOST RE

CENT EMPLOYER _______________________________________________________________________

COMPANY NAME CITY STATE ZIP

ARE YOU CURRENTLY WORKING FOR THIS EMPLOYER?

Yes No IF YES, MAY WE CONTACT? Yes No

__________________________________________________________________________________________________________________________

JOB TITLE SUPERVISOR NAME COMPANY PHONE

__________________________________________________________________________________________________________________________

JOB DUTIES

FROM:

__________________ TO: ____________________ $______________ PER __________________________________

DATES EMPLOYED (SALARY, HOUR, WEEK, MONTH)

REASON

FOR WANTING TO LEAVE

MOST RECENT EMPLOYER ____________________________________________________________________

COMPANY NAME CITY STATE ZIP

__________________________________________________________________________________________________________________________

JOB TITLE SUPERVISOR NAME COMPANY PHONE

__________________________________________________________________________________________________________________________

JOB DUTIES

FROM:

__________________ TO: ____________________ $______________ PER __________________________________

DATES EMPLOYED (SALARY, HOUR, WEEK, MONTH)

REASON FOR

LEAVING:

MOST RECENT EMPLOYER ____________________________________________________________________

COMPANY NAME CITY STATE ZIP

__________________________________________________________________________________________________________________________

JOB TITLE SUPERVISOR NAME COMPANY PHONE

__________________________________________________________________________________________________________________________

JOB DUTIES

FROM:

__________________ TO: ____________________ $______________ PER __________________________________

DATES EMPLOYED (SALARY, HOUR, WEEK, MONTH)

REASON FOR

LEAVING:

MOST RECENT EMPLOYER _____________________________________________________________________

COMPANY NAME CITY STATE ZIP

_________________________

_________________________________________________________________________________________________

JOB TITLE SUPERVISOR NAME COMPANY PHONE

__________________________________________________________________________________________________________________________

JOB DUTIES

FROM:

__________________ TO: ____________________ $______________ PER __________________________________

DATES EMPLOYED (SALARY, HOUR, WEEK, MONTH)

REASON FOR

LEAVING:

Have you ever been terminated or asked to resign by any employer? Yes No If yes, provide employer, date and

circumstances: _______________________________________________________________________________________

____________________________________________________________________________________________________

HR 100 (02/09) ~ 3 ~

EMPLOYMENT APPLICATION

HR 100 (02/09) ~ 4 ~

DRIVER’S LICENSE INFORMATION

Yes No If the job requires, do you have the appropriate valid driver’s license?

Name on license _____________________________________ DL # _____________________________

Type ______________________________________________ State of Issue_______________________

Yes No Have you had any moving violations within the last 7 years: Please Describe ________________________

______________________________________________________________________________________

Yes No Have you had your driver’s license suspended or revoked or had your driving privileges modified by a court

of law? If yes, give reason ________________________________________________________________

Please list all states from which you hold or have held a driver's license: _________________________________________

CRIMINAL HISTORY

Please note that a “Yes” answer of the following questions will not necessarily disqualify you from employment. However,

applicants convicted of certain criminal offenses may be ineligible for employment under applicable Texas law. Factors such

as the age and time of the offense, seriousness and nature of the violations, and rehabilitation will be considered when making

any employment decisions. Use additional paper if necessary for each of the following:.

Yes No Have you ever been convicted of a crime? Do not include convictions that were sealed or expunged pursuant

to a court order. Please explain any “Yes” answer. ____________________________________________

____________________________________________________________________________________

Yes No Are you currently awaiting trial for any criminal offense? Please explain any “Yes” answer. ___________

______________________________________________________________________________________

Yes No Have you ever initiated an act of violence in the workplace? ? Please explain any “Yes” answer. ________

______________________________________________________________________________________

PERMISSION TO WORK IN THE UNITED STATES

Yes No Are you legally eligible to work in the United States? Proof of employment eligibility will be required if hired.

PLEASE COMPLETE THIS PART ONLY

IF YOU ARE APPLYING FOR A POSITION IN

CHILDCARE, CASE MANAGEMENT, CHILD

CARE SERVICES OR COUNSELING

Describe work, volunteer or personal experiences in supervising groups of children.

____________________________________________________________________________________________________

Describe how your knowledge, skills and abilities fit the job position.

____________________________________________________________________________________________________

Do you prefer to work with a specific age, group or sex? Explain reason _________________________________________

____________________________________________________________________________________________________

Other comments relating to work with groups of children and youth on a daily basis.

__________________________

___________________________________________________________________________________

EMPLOYMENT APPLICATION

HR 100 (02/09) ~ 5 ~

APPLICANT NOTE

The Ministry is a faith-based, non-profit corporation, serving children and families in need. Some of the Ministries are licensed and

actively regulated by the Texas Department of Family and Protective Services and are frequently and periodically audited and

reviewed by licensing investigators for compliance with State Licensing Standards and the Texas Family Code.

The Ministry is an equal opportunity employer and does not discriminate in employment on the basis of race, color, sex, national

origin, disability, or age. Employment decisions are subject to the legitimate business requirements of the Ministry and are based on

an individual's qualifications, merit, and performance. As a religious, nonprofit institution, the Ministry is exempt from the general

duty to be nondiscriminatory on the basis of religion in employment and reserves the right to prefer employees or prospective

employees on the basis of religion. All employees must adhere to our Statement of Faith. This prerequisite for employment is based

upon federal guidelines provided in Title VII.

Please state your religion and the community of faith in which you are a member ____________________________________

The Ministry will cooperate fully with all law enforcement authorities in the prosecution of any individual found to be involving or

exposing any child or young person in care, to any illicit activities and/or unlawful behavior(s).

This application form is intended for use in evaluating your qualifications for employment False or misleading statements during the

interview or on this form may result in the refusal to hire or termination of employment. This employment application, or the granting

of an interview, does not represent a contract of employment or a promise of future benefits by the Ministry. If hired, such

employment shall be considered “at-will” and this application is not intended to constitute a contract of continued employment.

Employment and compensation may be terminated by the Ministry at any time and for any reason whatsoever, with or without good

cause at the option of either the Ministry or the employee. It is further understood that this at-will employment relationship may not

be changed by any written document or conduct unless such change is specifically acknowledged in writing by an authorized

executive of the Ministry.

All employment offers must be made in writing by an authorized executive of the Ministry. Employment offers will be conditional on

the satisfactory completion of any required pre-hire verifications and screenings including, but not limited to, criminal background

checks, educational verifications, reference and job verifications, drug screenings, medical screenings, driving verifications and

verification of eligibility to work. No representative of the Ministry has the authority to enter into any oral agreement for employment

for a specified period of time or to make an oral agreement contrary to the foregoing.

Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment. After an offer

of employment, and prior to reporting to work, you may be required to submit to a medical review. Depending on Ministry policy and

the needs of the job, you may be required to complete a medical history form and may be required to be examined by a medical

professional designated by the Ministry. Smoking is prohibited in all indoor and outdoor areas of the Ministry’s facilities unless

designated smoking areas have been established at a particular location in accordance with applicable state and local law.

This application will be kept in the Ministry’s active files only until the position for which it was submitted is filled. If the applicant is

not hired, the applicant must complete a new application to be considered for employment.

CERTIFICATION AND RELEASE

I certify that I have read and understand the Applicant Note on this form and that the answers given by me to the foregoing questions

and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information,

omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my

application or discharge at any time during my employment. I authorize the Ministry and/or its agents, including consumer reporting

bureaus, to verify any of this information. I release all former employers, persons, schools, companies and law enforcement

authorities from any liability for any damage whatsoever for issuing this information. I release the Ministry (or its designee) from any

and all liability resulting from the verification of such information. I also understand that the use of illegal drugs is prohibited during

employment. If Ministry policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during

employment. If hired, I agree to comply with all applicable laws and the Ministries’ policies and procedures.

I have read and understand the above statements and agreements and understand the same. This application is complete and accurate

to the best of my knowledge.

SIGNATURE DATE

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