Employment Application

Please Fill Out the Form Below Completely and Accurately:

PLEASE FILL OUT ALL REQUIRED FIELDS OR THE APPLICATION WON'T SUMMIT PROPERLY.

Position Applying For?
Child Care Day ShiftChild Care Night ShiftAdministrativeOther

Date Available to Start

How did you hear about Father's Heart Ranch?
NewspaperEmployeeRadioOther

Personal Information

Your Full Name

Your Full Address

Your Telephone Number

Your Email

Are You 21 Years of Age or Older?
YesNo

Driver's Licence Number (DMV reports are required for applicants being considered for positions which will normally require them to drive for company business)

Date of Last T.B. Test

Date of Last Physical

Legal Verification

A. After employment, can you submit verification of your legal right to work in the United States?
YesNo

B. Have you worked at FHR previously?
YesNo

C. Any days/hours not available to work?

D. Did you serve in the military?
YesNo

E. With or without accommodation, can you perform the duties of this job?
YesNo

F. Have you ever been convicted of an offense other than the following?

1. Minor traffic violations for which the fine was $50 or less before April 5, 1984 or $100 or less on or after April 4, 1984 or

2. Any offense which was finally settled in a juvenile court or under a welfare youth offender law. (Offenses which fall under numbers 1 and 2 above need not be reported)

Employment is contingent upon clearance of your criminal record by Community Care Licensing.

YesNo

G.Has your driver's license ever been suspended or revoked?
YesNo

H.If you answered "YES" to either F or G above, please provide the following information for each event: The Date, Location, Nature and Disposition of the circumstance.

Education

Highest Year Completed in School

Did your receive a High-School Diploma?
YesNo

Are you currently enrolled in high-School Completion Courses?
YesNo

Undergraduate and Graduate Level Education

Please provide the following: Name of University, Major, Years Completed Units Completed, Degree, and Date Completed.

Completed Employment-Related Education Courses

Please provide the following: Course Title, Name of School or Organization & Location, Units and Date Completed.

Current Employment-Related Education Courses

Please provide the following: Course Title, Name of School or Organization & Location, Units and Date Completed.

Other Skills and Achievements

Describe any specialized training, apprenticeships, skills ans extra-curricular activities:

List any licenses or certificates that you hold:

List any honors you have received:

List professional, trade business, or civic associations of which you are a member (You may exclude groups which indicate race, color, religion, sex, age or other protected status):

What foreign languages do you speak, read, or write?

State any additional information you feel may be helpful to us in considering your application:

Employment History

Please give complete and accurate full-time and part-time employment records. Start with your present or most recent employment. You may include any job-related military service assignments and volunteer activities. (We reserve the right to contact all former employers)

Company One (current or most recent employer)

Company Name:

Telephone Number:

Address:

Dates of Employment:

Name of Supervisor:

Job Title:

Hours Worked Per Week:

Describe Responsibilities/Duties:

Reason for leaving:

Company Two (previous employer)

Company Name:

Telephone Number:

Address:

Dates of Employment:

Name of Supervisor:

Job Title:

Hours Worked Per Week:

Describe Responsibilities/Duties:

Reason for leaving:

Company Three (previous employer)

Company Name (previous employer):

Telephone Number:

Address:

Dates of Employment:

Name of Supervisor:

Job Title:

Hours Worked Per Week:

Describe Responsibilities/Duties:

Reason for leaving:

Personal References

List three persons who are not related to you, who are not previous employers and who can give information about your background, character, abilities, etc.

Personal Reference #1

Name:

Telephone Number:

Address:

Relationship:

Personal Reference #2

Name:

Telephone Number:

Address:

Relationship:

Personal Reference #3

Name:

Telephone Number:

Address:

Relationship:

Applicant's Statement

I certify that the answers given herein are true and complete to the best of my knowledge. If I am employed, I understand that false or misleading information given on this application or during interview(s) may result in discharge at any time.

I authorize investigation of all statements contained in this application. I authorize Father's Heart Ranch to contact any of my references, employers and/or schools to furnish any information concerning my employment, education, and/or background, character, abilities, etc. I release Father's Heart Ranch and all persons and organizations from all claims and liabilities of any nature arising from such inquiries and investigations.

I understand that employment depends upon the screening of my criminal history, TB clearance, physical examination and child abuse check.

I understand that employment at Father's Heart Ranch is "at will". If I am employed, I at my own discretion, or Father's Heart Ranch, at its own discretion, may terminate my employment at any time with or without cause and with or without notice.

By checking "Agree" below, I electronically certify and agree to all of the above statements.
AgreeDisagree

Additional Questions:

The following questions are related to the child care worker position for which you are applying. Please write a short paragraph in response to each of these questions.

1. After having enjoyed a weekend off, you arrive to work at the group home on Monday morning. One of the clients with whom you have developed a good rapport approaches you and says, "I have a secret to share with you but you can't tell anyone else." She proceeds to tell you that during a recent home visit, she was molested by a family member. How would you handle this situation?

2. A child who was recently placed at Father's Heart Ranch challenges your level of concern for his well-being. After a small verbal battle he states, "You don't care about me and neither does anyone else at this place-you all get paid to be here!" How would you respond to this?

3. If you could establish your own discipline policy for a group home, what would it be?


Father’s Heart Ranch is an equal opportunity provider and employer.