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P. O Box 1373 • San Benito Texas 78586
Phone: (956) 399-5356 Fax: (956) 399-3634 • jay@sunnyglen.org
 

AN EQUAL OPPORTUNITY EMPLOYER
Applicants are considered for all positions without regard to race, color, sex,
national origin, age, veteran status or disability
 
 
Today's date Month
 
Name Last First Middle
 
Address
Street
City State Zip
Please list all residences in the past five years
 
Social Security Number - - Date of birth / /
 
Do you have a driver's license? Yes No
Driver's License # Number State
 
Home telephone (
Work telephone (
e-mail
 
How were you referred to us?
Newspaper (location)
Job Fair (location)
Website (address)
Person (name)
 
Have you applied with is before? Yes No
If yes, please give date / / Job title
 
Have you been employed with is before? Yes No
If yes, please give date / / Job title
 
Do you have relatives currently employed here? Yes No
If yes, please give name and relationship
 
Are you a relative of a resident? Yes No
If yes, please give name and relationship
 
Are you an alumni? Yes No
If yes, please give dates
 
Are you currently employed? Yes No
 
May we contacy your present employer? Yes No N/A
 

What is your minimum salary requirement (Please state in dollars) $
"Please do not write "negotiable")

 
 
1. Can you furnish proof of citizenship or immigration status upon employment? Yes No
 
2. Are you on a lay-off and subject to recall? Yes No
 
3. Can you travel if a job requires? Yes No
 
4. Have you ever been convicted of a Felony / Misdemeanor? Yes No
If yes has been checked please complete below:
State
Date / /
Explain
 
5. Have you ever been arrested, placed on probation or placed on deferred adjudication for violating any criminal law? Yes No
If yes has been checked please complete below:
State
Date / /
Explain
 
After review of the job description for this position, do you believe you are able to perform the essential functions of this position, with or without reasonable accommodations? Yes No
 
Professional Licensure
Professional License #
Type
Date Acquired / / ExpirationDate / /
Professional License #
Type
Date Acquired / / ExpirationDate / /
Professional License #
Type
Date Acquired / / ExpirationDate / /
 
Have you ever had your professional license suspended or revoked? Yes No
 
Education
 
Please note that college degrees must be from an accredited university in order to be considered for employment.
Proof of education is required in the event that a conditional job offer is made.
 
Elementary School
Name of school
 
High School
Name of school
Diploma GED Did not grduate
Honors or awards received
 
Vocational or Trade School
Name of school
Type
Date Received / /
Honors or awards received
 
College or University
Name of school
Number of hours
Associate (type)
Bachelors (type)
Date Received / /
Honors or awards received
 
Graduate or Professional
Masters (type)
Date Received / /
Field
 
Doctorate (type)
Date Received / /
Field
 
Employment Record
 
This section must be completed, even if you are attaching a resume. Begin with your present or most recent employment. Include self-employment, summer or part-time jobs, and military service assignments for the PAST 15 YEARS.
 
Employer
Address
City State Zip
Phone ( ) -
Job Title
Supervisor
Did you voluntarily resign? Yes No N/A
Specific reason for leaving
Date Employed: From / / To / /
Final salary $
Summary of work performed
 
Employer
Address
City State Zip
Phone ( ) -
Job Title
Supervisor
Did you voluntarily resign? Yes No N/A
Specific reason for leaving
Date Employed: From / / To / /
Final salary $
Summary of work performed
 
Employer
Address
City State Zip
Phone ( ) -
Job Title
Supervisor
Did you voluntarily resign? Yes No N/A
Specific reason for leaving
Date Employed: From / / To / /
Final salary $
Summary of work performed
 
Employer
Address
City State Zip
Phone ( ) -
Job Title
Supervisor
Did you voluntarily resign? Yes No N/A
Specific reason for leaving
Date Employed: From / / To / /
Final salary $
Summary of work performed
 
Employer
Address
City State Zip
Phone ( ) -
Job Title
Supervisor
Did you voluntarily resign? Yes No N/A
Specific reason for leaving
Date Employed: From / / To / /
Final salary $
Summary of work performed
 
General Information
Please use this space to describe your knowledge, skill and attitude
which would enhance your qualifications for this position:
 
 
APPLICANT’S CERTIFICATION AND AGREEMENT
Please read carefully before signing

 

In consideration of being employed, I understand and agree that:

The receipt of this application does not imply any guarantee of employment.

If I misrepresent or omit any information on this application and/or the House Parent Questionnaire (if applicable), I may be refused employment or if employed, I may be terminated.

Sunny Glen Children’s Home has my authorization to thoroughly investigate my employment and personal history (which may include information concerning my character, criminal convictions, mode of living, general reputation, personal characteristics and related pertinent information) and I hereby consent to take any test, whenever the organization deems it necessary, in any employment investigation. I will hold no person, corporation or organization liable for my giving or its receiving information in such investigation.

If employed, I may terminate my employment at any time, without notice or cause, and the employer may terminate or modify the employment relationship at any time without prior notice or cause. If employed, I understand that my employment is for no definite period of time.

In consideration of my employment, I agree to comply with the rules, regulations and policies of the employer.

If employed, I understand that no representative of the employer, other than the Exec. Dir. of the organization, has any authority to enter into any agreement, oral or written, for employment for any specific period of time or to make any agreement or assurance contrary to this policy.

Any physician, hospital or testing laboratory has my consent to conduct medical examinations or drug screening tests on me, and I hereby give my consent for all such information to be released for the employer to determine my abilities to perform my job, now or in the future. I also give my consent to physical searches of myself and my brief case, lunch box, vehicle, locker, purse, cottage or any packages I have while on the employer’s premises, whether or not I have a lock on such items.

The needs of the employer may make the following conditions mandatory: overtime, shift work, rotating work schedules, or a work schedule other than Monday through Friday. I accept these conditions of employment.

The employer is an equal opportunity employer. The employer does not discriminate on the basis of race, color, sex, national origin, age, veteran status or disability, and no question on this application is used for the purpose of limiting or excluding any applicant’s consideration for employment on any basis prohibited by federal, state or local law.

I have read and agree to the above and hereby certify that the facts I have provided in my employment application are true and complete.

 
Name Date
 
This application is current and active for a period of one (1) year.
 

References

YOU MUST SUBMIT FOUR (3) REFERENCE LETTERS WITH THIS APPLICATION FROM THE LIST OF PERSONS YOU HAVE PROVIDED BELOW.
Failure to complete this page may delay the processing of your application.
You must provide us with DAYTIME PHONE NUMBERS FOR YOUR REFERENCES.
 
Name Date
Position applied for
 
Personal References (must be non-relatives)
 
Name
Address
City State Zip
Daytime Phone ( ) -
How long have you known this person?
This person's profession is
 
Name
Address
City State Zip
Daytime Phone ( ) -
How long have you known this person?
This person's profession is
 
Name
Address
City State Zip
Daytime Phone ( ) -
How long have you known this person?
This person's profession is
 
House Parent Questionnaire
 
Name Date
We are delighted that you are interested in becoming a house parent with the Sunny Glen Children’s Home. The Following questions are designed so that we more about you & your suitability for house parenting. Please answer the questions in your own words.. You can use additional sheets, if necessary.
 
1. Please explain the reason for your interest in becoming a house parent
 
2. What is your definition of a “good” child?
 
3. What is your definition of a “bad” child?
 
4. What is your definition of a “good” parent?
 
5. What is your definition of “proper discipline” for children?
 
6. What are your (2) greatest STRENGTHS & (2) greatest WEAKNESSES in working with children?
 
7. What do you do when you become angry or frustrated? (BE SPECIFIC)
 
8. What causes you stress & how do you deal with it?
 
9. Do you have children? If so, complete the section below?
Name Gender Age Does the child reside with you?
M F Yes No
M F Yes No
M F Yes No
M F Yes No
 
10. Will your children in any way prevent you from performing your job duties as a house parent or adversely affect the environment of our residents? If so, please explain below:
 
11. Please explain (in detail) your housekeeping routine:
 
12. How do you rate yourself in the area of adapting to change?
 
13. Please explain your views regarding the significance of Christianity in the lives of people.
14. How do you feel about working with infants and toddlers (i.e. changing diapers, feeding, etc…)?
 
15. What are your thoughts on the use of psychotropic medications with youths?
 
Please click to submit form online
 

 
 

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