Name:

Primary phone number:

Alternate phone number:

REQUIRED. Email address:

Street address:

Position(s) applied for:

Preferred location(s):
Abilene
Austin
Corpus Christi
Corsicana
Dallas
Duncanville
Fort Worth
Houston
Itasca
Kilgore
Longview
Lubbock
Midland
Odessa
San Antonio
Shreveport
Temple
Waxahachie
Wichita Falls

Desired salary range (applicants for employment only):

Earliest start date:

Type of work desired (applicants for employment only):
Full-Time
Part-Time
Temporary

Have you submitted an application here before?
Yes
No
If yes, give dates:

Have you been an employee, foster parent, or volunteer here before?
Yes
No
If yes, give dates:

Do you have relatives who are currently an employee, foster parent, or volunteer here?
Yes
No
If yes, provide their name(s):

Proof of identity and legal authority to work in the United States will be required upon engagement. Are you legally eligible for employment in the United States (applicants for employment only)?
Yes
No

Are you 18 years of age or older (or 21 if Houseparent or Family Teacher position)?
Yes
No

Would you be able to perform, with or without reasonable accommodation, the essential functions of the position(s) for which you are applying?
Yes
No

Would you be able to meet the attendance requirements of the position(s)?
Yes
No

Criminal history, child abuse and neglect registry, and, if applicable, motor vehicle record searches will be conducted on you. Have you ever been convicted of or pled guilty or no contest to a crime (excluding minor traffic violations)? Answering yes will not automatically disqualify you.
Yes
No
If yes, please explain offense(s), jurisdiction(s), and final disposition(s):

High School (include city and state):

Number of years completed:

Did you graduate?
Yes
No

School (include city and state):

Course of study:

Number of years completed:

Did you graduate?
Yes
No
Degree received:

School (include city and state):

Course of study:

Number of years completed:

Did you graduate?
Yes
No
Degree received:

Employer:

From (month/year):

To (month/year):

Job title(s) and work performed:

Supervisor:

Phone number:

Street address:

Starting pay:

Final pay:

Reason for leaving:

Employer:

From (month/year):

To (month/year):

Job title(s) and work performed:

Supervisor:

Phone number:

Street address:

Starting pay:

Final pay:

Reason for leaving:

Employer:

From (month/year):

To (month/year):

Job title(s) and work performed:

Supervisor:

Phone number:

Street address:

Starting pay:

Final pay:

Reason for leaving:

Employer:

From (month/year):

To (month/year):

Job title(s) and work performed:

Supervisor:

Phone number:

Street address:

Starting pay:

Final pay:

Reason for leaving:

List any employers that you do not want us to contact for a reference and explain why:

Have you ever been discharged by a company or resigned under threat of discharge?
Yes
No
If yes, give company name(s) and reason(s) for discharge:

From (month/year):

To (month/year):

Describe your activities:

From (month/year):

To (month/year):

Describe your activities:

Do you have a valid driver license?
Yes
No
If yes, which state?

Are you bilingual?
Yes
No
If yes, what language(s)?

Summarize any training, skills, licenses, and/or certificates that may qualify you for the position(s):

Word
Excel
Access
PowerPoint
Outlook
Internet

Describe any business and civic activities and any offices you hold or have held:

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

How did you hear about the position?

What led you to apply?

Name:

Relationship to applicant:

Number of years known:

Phone number:

Street address:

Name:

Relationship to applicant:

Number of years known:

Phone number:

Street address:

Name:

Relationship to applicant:

Number of years known:

Phone number:

Street address:

Why do you want to work with children?

With what age group and gender do you prefer to work? Why?

Describe the three greatest strengths or assets you have in working with children:

Describe the three most serious weaknesses or problems you have in working with children:

REQUIRED. Do you acknowledge that you have read, fully understand, and accept all terms of the foregoing Applicant Statement?
Yes