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
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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
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)
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.
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