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Application for Employment

This application form is intended for use in evaluating your qualifications for placement.  This is not an employment contract.  Please answer all appropriate questions completely and accurately.  False or misleading statements during the interview and on this form, are grounds for terminating the application process, or if discovered after placement, terminating placement.  Additional testing of job-related skills and for the presence of drugs in your body may be required prior to placement.

APPLICANT INSTRUCTIONS: If you need help filling out this application form or with any phase of the placement process, please notify the person that gave you this form and every reasonable effort will be made to accommodate your needs.

Please answer each question.

Consistent with relevant law, the information on this application will not be disclosed to unauthorized persons. 

Pay Range: $16-21, dependent on experience and education level.

APPLICANT INFORMATION

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JOB RELATED SKILLS

Note: Do not fill out any part of this section you believe is non-job related.  If you choose to disregard any question in this section, please briefly note your reasons.

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THREE PROFESSIONAL REFERENCES

PERSONAL REFERENCE

SECURITY

Please list all states and countries you have lived in since the age of 18 (most recent first):

EMPLOYMENT HISTORY

Identify all employers for whom you have worked in the last ten years.  Include part-time and temporary employers.  List your most recent employer first.  “See Resume” is not an acceptable response.

  • Please describe your activities during any gaps in employment in the last ten years. Do not include leave or time off due to illness or medical treatment.

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EDUCATION

LICENSES, CERTIFICATION, AND SPECIAL SKILLS

Please identify all professional and other licenses or certifications you currently hold or have held previously:

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APPLICANT'S STATEMENT

In consideration of the receipt and evaluation of this application by Children’s Village, I hereby release Children’s Village and any individual, employer, reference, or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family on account of compliance or any attempts to comply with this authorization.  I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application.

I understand and agree it is critical to Children’s Village that all employees conform to the highest standards of safety, interpersonal conduct, and sexual morality when clients or minors are involved.  I affirm that I will strictly comply with Children's Village policies and procedures, including those concerning child safety and protection, sexual abuse and misconduct, and interpersonal relationships.  I understand and agree that failure by me to abide by such policies and procedures may result in my immediate dismissal, or disciplinary action, all in the sole discretion of the Children's Village.

If hired, I understand my employment is at will and can be terminated at the discretion of Children’s Village or at my option, without notice, at any time, except as specifically set forth in writing in a current individual employment agreement, if any, which I have entered into with Children’s Village. Absent such a written employment agreement, I understand I will be an at will employee, if hired.

Availability:

We are a 24 hour residential home. What is your availability? The more open your availability, the higher the chance we can bring you in for an interview. If your availability is restricted to only certain days, the likelihood is low that we will be able to hire you. 

Please include ALL shifts you are available to work, not what you prefer.

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Thank you for applying to join the Children's Village Team!

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