EMPLOYMENT APPLICATION

EQUAL OPPORTUNITY EMPLOYER.  It is our policy to abide by all Federal and State laws prohibiting employment discrimination solely on the basis of a  person's race, color, creed, national origin, religion, age (over 40), sex marital status, or physical or mental disability, except where a reasonable, bona fide  occupational qualification exists.

 EMAIL ADDRESS  Name  

 Address  City State

Zip Code
How many years?

 Day Phone     Home Phone

 Position for which you are applying Child Care Counselor MFTI ACSW

 Check the following options you would consider Full Time Part Time | Other

Morning Day Evening OverNight Weekends

 If Part Time, specify hours or days  What is your minimum salary requirement? Date available for work

 Do you have any commitments to another employer that might affect your employment with us?

EDUCATION AND TRAINING

 


School Name


City and State

Degree/
Major Course Study


Degree Recieved

 High School

 

 

 

 College            

 

 

 

 

 Graduate School

 

 

 

 


  List any other education, training, special skills or certificates licenses that you possess related to the job

   

 

 List any languages that you fluently speak Read/Write  Do you have a valid driver's license in this state?          


 GENERAL INFORMATION
 Are you 21 years old or over?                

 During the last ten years, have you ever been convicted of, plead quality to, or received probation, deferred adjudication, or any other type of alternative method of supervision or correction  for a felony or a misdemeanor, having a penalty of imprisonment or a fine of over $500?  (Answering yes is not an automatic bar to employment but will be considered in relation to specific  job requirements.)

 If yes, explain


 EMPLOYMENT HISTORY 1
 List all work experience beginning with present or most recent job (use back of application, if necessary)

 ame of employer Type of Business  City   State

 Dates employed (From to) Title

 Brief Description of Duties

 Reason for Leaving

EMPLOYMENT HISTORY 2
 List all work experience beginning with present or most recent job (use back of application, if necessary)

 Name of employer Type of Business  City   State

 Dates employed (From to) Title

 
 Brief Description of Duties

 Reason for Leaving

EMPLOYMENT HISTORY 3
 List all work experience beginning with present or most recent job (use back of application, if necessary)

 Name of employer Type of Business  City   State

 Dates employed (From to) Title

 Brief Description of Duties

 Reason for Leaving

 REFERENCES (List three professional refferences whom know you for at least three years)

NAME OCCUPATION/ASSOCIATION       PHONE

 Person to be notified in case of emergency:

 Name             Telephone  Relationship

 Please include any other information you thank would be helpful to us in considering you for employment, such as additional work experience, articles/books published, activities, honors  received, etc.  (You may omit all information that would indicate age, sex, sexual orientation, race, religion, color, national origin, disabilities.)

 

 

AGREEMENT (Please read the following statement carefully.)

 I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to be the best of my knowledge.  I also agree that falsified information or  significant omissions may disqualify me from further consideration for employment and any be considered justification for dismissal if discovered at a later date.

 I authorize all persons listed above (and on the accompanying resume, in any) to give For The Future Group Home any and all information concerning my previous employment and education and any pertinent  information they may have, personal or otherwise, and release all parties, such persons and For The Future Group Home, from liability for any damage that may result from furnishing same to For The Future Group Home.

 If employed by For The Future Group Home, i agree to abide by the policies and procedures of For The Future Group Home.  I further understand that my employment can be terminated, with or without cause or notice, at any time,  at the discretion of For The Future Group Home,.  I further understand that no manager or representative or For The Future Group Home has authority to enter into any agreement, oral or written, on behalf of For The Future Group Home for a term  of employment or to make any assurance or promise of continued employment.