METHODIST CHILDREN'S HOME

Mission Statement: Methodist Children's Home offers hope to children, youth and families through a nurturing, Christian community.

Address:

City-State-Zip:

Position Desired:

Source

Telephone #1

Tel.#2 (Cell)

E-mail:

When?____________________ Where?______________________

List friends working for the Home: 

List Relatives

Is your Driver's License active? Yes       No Note: You must have an active Driver's License for all current positions.

Do you have valid auto liability insurance coverage? Yes       No    

Where?

Have you had 3 or more traffic tickets or accidents in the last 3 years? Yes       No     Where________________

Have you been convicted of, or have you pleaded guilty or no contest (nolo contendere) to a felony or misdemeanor offense?Yes       No

Do you have criminal charges pending against you at this time? Yes       No     Charges:____________________

If the answer to any questions is yes, please explain:

Describe any skills, strengths or experiences which would help you in the job you desire here._______________

____________________________________________________________________________________________

Methodist Children's Home does not discriminate based on sex, race, color, religion, national origin, age, veteran status or political beliefs. Physical or mental challenges will not disqualify an applicant who meets bona fide job requirements.

The Home does not knowingly employ individuals or contribute funds to organizations found on terrorist lists promulgated by the U.S. Government, the U.N., or the European Union.

Beginning with your current or most recent job, complete the following information for both full-time and part time jobs. Account for all time periods. Methodist Children's Home may contact these companies regarding employment unless noted below.

Address:__________________________________

City-State-Zip:______________________________

Your Position:______________________________

Name/Title of Supervisor:

Date Left:_____________________________

Telephone & extension:__________________

Last Pay Rate:_________________________

Dept. Worked:_________________________

Reason for Leaving:

Do not contact because:_____________________________________________________________________

Address:__________________________________

City-State-Zip:______________________________

Your Position:______________________________

Name/Title of Supervisor:

Date Left:_____________________________

Telephone & extension:__________________

Last Pay Rate:_________________________

Dept. Worked:_________________________

Reason for Leaving:

Do not contact because:_____________________________________________________________________

Address:__________________________________

City-State-Zip:______________________________

Your Position:______________________________

Name/Title of Supervisor:

Date Left:_____________________________

Telephone & extension:__________________

Last Pay Rate:_________________________

Dept. Worked:_________________________

Reason for Leaving:

Do not contact because:_____________________________________________________________________

Other comments relating to working with a group of children & youth on a daily basis.

____________________________________________________________________________________________

College/University

____________________________________________________________________________________________

Other

____________________________________________________________________________________________

2.____________________________________________________________________________________________

3.____________________________________________________________________________________________

Employment at Methodist Children's Home involves working with troubled children and may be very stressful at times. Any past experience with emotional or nervous disorders should be considered prior to accepting a position with this organization.

If hired, I agree to conform to the policies and procedures of Methodist Children's Home. I understand that my employment may be terminated at any time, with or without cause and with or without notice, at the option of either the employee or Methodist Children's Home.

I authorize Methodist Children's Home or its representative to verify any information contained in this application and/or the attachments. I further authorize Methodist Children's Home to verify and/or secure other information relating to my employment with the Methodist Children's Home including but not limited to education and training data, previous employment data, driving records, and arrest/conviction records, etc.

I agree that any misrepresentations made by me on the application or during related interviews may result in the withdrawal of an offer of employment or termination of employment if I have begun work without any obligation or liability to me except for payment for actual services rendered.

In a diligent effort to protect the children we serve from further forms of abuse, neglect or other victimization, the Home is required to thoroughly screen and hold all staff members to a very high degree of accountability and professional conduct. All applicants for employment will be screened by thorough: sex offender registry check, criminal history and central registry background checks; driving records checks; personal and employment reference checks; and drug testing. Additionally, the Home reserves the right to require any employee to submit to a drug or alcohol screen if there is cause or reason to believe that the employee is under the influence of either alcohol or illegal drugs.

The Home will also 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).

As an applicant and potential new employee for the Home, do you consent to a pre-employment drug/alcohol screen? Yes       No

It is the practice of the Home to provide For Cause drug/alcohol screening. Do you consent to a drug/alcohol screen if employed and required to do so as a result of suspicious behavior(s) while on duty? 
Yes       No

Please note: References and/or data that cannot be verified could delay the applicant from further consideration for employment. I have read and understand the conditions for employment identified above.

Name of Applicant Printed _______________________________________

Signature __________________________________________

Date ____________________________ Reviewed by _________________