Are you at least 18 years old?* Are you at least 18 years old?* Yes No

Today's Date*

First Name*

Middle Name

Last Name*

Maiden Name

Email Address*

Address*

City*

State

Zip Code*

Home Phone

Cell Phone

Availability (Hours you are available)*

Have you previously submitted an Application?* Have you previously submitted an Application?* Yes No

Have you worked with Children's Hope before?* Have you worked with Children's Hope before?* Yes No

If yes, enter the date you left and reason.

High School*

High School City/State

Highest High School Grade Completed* Highest High School Grade Completed* Freshman Sophmore Junior Senior Graduate GED

College/University

College/University City and State

Highest College Level Completed Highest College Level Completed Freshman Sophmore Junior Senior Associates Bachelors Masters PhD

Additional Education

Current/Most Recent Employer

Previous Employer

Current Company Name

Previous Company Name

Current Company Address

Previous Company Address

Current City, State, Zip of Employer

Previous Company City, State & Zip

Current Supervisors Name

Previous Supervisors Name

Current Supervisors Phone

Previous Supervisors Phone

Current Position or Title

Previous Position or Title

Describe your Current Job

Describe your Previous Job

Date Hired for Current Job

Date Hired for Previous Job

Date Left Current Job

Date Left Previous Job

Reason for Leaving your Current/Most Recent Job

Reason for Leaving your Previous Job

Explain any time period you were not working*

Have you ever been terminated or asked to resign? If YES, please explain:

I hereby authorize Children's Hope Residential Services to conduct a Criminal Background Check for Mentor/Volunteer consideration* I hereby authorize Children's Hope Residential Services to conduct a Criminal Background Check for Mentor/Volunteer consideration* Yes No

Printed Full Name (E-Signature)

APPLICATION ESSAY

What qualifications do you feel you have to work with emotionally disturbed children?

APPLICATION QUESTIONS

Why are you applying with Children's Hope?

How did you Learn about this Opportunity?

Our Programs are based on building relationships with our clients. All of the children have suffered trauma. What steps would you take to begin a relationship?

Confidentiality is a legal requirement (HIPPA) in our agency. What is your definition of confidentiality?

How do you describe "Integrity"?

Tell us about a situation when and how you handled Dishonesty in the workplace.

Give us some examples of how you acted with integrity in your job or with work relationships.

What is your definition of Customer Service?

Describe a situation when there was a problem with a customer and how you handled it.

Communication (Verbal & Nonverbal) are skills required in this position. Describe what you believe to be important steps in communication.

What do you do to show people you are listening?

How do you handle stress?

What are your strengths?

What is your greatest weakness? How do you make them strengths?

How would you handle a peer who was not performing job duties correctly?

A supervisor has asked you to perform a task incorrectly, how would you handle the situation?

What are some reasons you would want to work here?

What do you want to gain from this experience? Personal Goals?

What skills do you have that would help you in this job?

What would your last supervisor say about you?

Boundaries are extremly important. None of the children should know anything about your personal information. Boundaries imply professional distance, respect and protect the client from harm. Specific rules may vary according to the setting, but the principle of doing no harm to the clients remains the same. Do you understand and agree about the companies boundaries? Boundaries are extremly important. None of the children should know anything about your personal information. Boundaries imply professional distance, respect and protect the client from harm. Specific rules may vary according to the setting, but the principle of doing no harm to the clients remains the same. Do you understand and agree about the companies boundaries? Yes No

We have discussed some of the physical and schedule requirements for this position, will you be able to comply with the requirements? We have discussed some of the physical and schedule requirements for this position, will you be able to comply with the requirements? Yes No

BACKGROUND CHECK INFORMATION

Full Name*

Maiden Name

Date of Birth (MM/DD/YYYY)*

Email Address*

Place of Birth (State)*

Telephone*

Gender* Gender* Male Female

Ethnicity* Ethnicity* Hispanic Not Hispanic

Race* Race* American Indian/Alaskan Native Native Hawaiian/Pacific Islander Asian-American African-American Caucasian Other

Height*

Weight*

Hair Color*

Eye Color*

Physical Address (No PO Boxes)*

City*

State*

Zip*

Mailing Address (If different)

Have you ever been convicted of a crime?*

If Yes, for What, When and How?*

List all cities where you have lived in the state of Texas (Required)*

Have you lived Outside the State of Texas in the last 5 years?* Have you lived Outside the State of Texas in the last 5 years?* Yes No

If Yes, please explain*

List all City/States where you have lived:*

I hereby authorize Children's Hope Residential Services to conduct a Criminal Background Check for employment consideration / continued employment. I hereby authorize any law enforcement agency to furnish Children's Hope Residential Services, or its agent information related to my criminal history. I hereby release Children's Hope Residential Services and all of its agents and employees, the law enforcement agency furnishing information, from all liability resulting from the furnishing of this information to Children's Hope Residential Services. I certify that the statements made by me on this form are true, complete and correct to the best of my knowledge and belief and are made in good faith. I understand that any false statements made herein will void my consideration for employment / continued employment and could result in disciplinary action including termination. Should I receive and accept an offer of employment with Children's Hope Residential Services, Inc. I understand that this authorization will be perpetual for the duration of my employment. I hereby authorize Children's Hope Residential Services to conduct a Criminal Background Check for employment consideration / continued employment. I hereby authorize any law enforcement agency to furnish Children's Hope Residential Services, or its agent information related to my criminal history. I hereby release Children's Hope Residential Services and all of its agents and employees, the law enforcement agency furnishing information, from all liability resulting from the furnishing of this information to Children's Hope Residential Services. I certify that the statements made by me on this form are true, complete and correct to the best of my knowledge and belief and are made in good faith. I understand that any false statements made herein will void my consideration for employment / continued employment and could result in disciplinary action including termination. Should I receive and accept an offer of employment with Children's Hope Residential Services, Inc. I understand that this authorization will be perpetual for the duration of my employment. Yes

E-Signature*

Date:*

Number