Employment Application

All fields with an asterisk (*) denote a required field
This employment application is very extensive and may take time to complete. To reduce the risk of losing your progress, it is recommended that you fill out all essays and short answer questions offline in a word document. Once completed, you may can copy and paste your responses into this form.

Personal Information

First Name *:

Middle Name:

Last Name *:

Primary phone number *:

Alternate phone number:

Email Address *:

Physical Address:


Position

Position(s) applied for:

Preferred location(s):
AbileneAustinBaton-Rouge
Corpus-ChristiCorsicanaDallas
DuncanvilleFort-WorthHouston
HurstItascaKilgore
LongviewLubbockMidland
New-OrleansOdessaSan-Antonio
ShreveportTempleWaxahachie
WeatherfordWichita-Falls

Desired salary range (applicants for employment only):

Earliest start date:

Type of work desired (applicants for employment only):
Full-TimePart-TimeTemporary

Have you submitted an application here before?
YesNo

If yes, give dates:

Have you been an employee, foster parent, or volunteer here before?
YesNo

If yes, give dates:

Do you have relatives who are currently an employee, foster parent, or volunteer here?
YesNo

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)?
YesNo

Are you 18 years of age or older (or 21 if Home Parent position)?
YesNo

Would you be able to perform, with or without reasonable accommodation, the essential functions of the position(s) for which you are applying?
YesNo

Would you be able to meet the attendance requirements of the position(s)?
YesNo

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.
YesNo

If yes, please explain offense(s), jurisdiction(s), and final disposition(s):

Educational Background

High School (include city and state):

Number of years completed:

Did you graduate?
YesNo

School (include city and state):

Course of study:

Number of years completed:

Did you graduate?
YesNo

Degree received:

School (include city and state):

Course of study:

Number of years completed:

Did you graduate?
YesNo

Degree received:

Employment Background

Starting with your most recent employer, provide the following information for all employment since high school or during at least the last 10 years. Indicate if you were employed under a different name.

Most Recent/Current Employer:

From (month/year):

To (month/year):

Job title(s) and work performed:

Supervisor:

Phone Number:

Street address (include city, state, and Zip):

Starting pay:

Final pay:

Reason for leaving:

Previous Employer:

From (month/year):

To (month/year):

Job title(s) and work performed:

Supervisor:

Phone Number:

Street address (include city, state, and Zip):

Starting pay:

Final pay:

Reason for leaving:

Previous Employer:

From (month/year):

To (month/year):

Job title(s) and work performed:

Supervisor:

Phone Number:

Street address (include city, state, and Zip):

Starting pay:

Final pay:

Reason for leaving:

Previous Employer:

From (month/year):

To (month/year):

Job title(s) and work performed:

Supervisor:

Phone Number:

Street address (include city, state, and Zip):

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?
YesNo

If yes, give company name(s) and reason(s) for discharge:

Account for any time that you were not employed since leaving school and between positions during at least the last 10 years:

From (month/year):

To (month/year):

Describe your activities:

From (month/year):

To (month/year):

Describe your activities:

General Information

Do you have a valid driver license?
YesNo

If yes, which state?

Are you bilingual?
YesNo

If yes, what language(s)?

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

Please check all that apply:
WordExcelAccessPowerPointOutlookInternet

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

Presbyterian Children's Homes and Services (PCHAS) is a religious organization affiliated with the Presbyterian Church (U.S.A.) and prefers to employ individuals who are committed Christians and who possess a Christian commitment, as well as concern, for children and families in need. PCHAS indicates a preference based upon religion because it is a bona fide occupational qualification for the job.

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?

Personal References

Name:

Relationship to applicant:

Number of years known:

Phone Number:

Street address (include city, state, and Zip):

Name:

Relationship to applicant:

Number of years known:

Phone Number:

Street address (include city, state, and Zip):

Name:

Relationship to applicant:

Number of years known:

Phone Number:

Street address (include city, state, and Zip):

Positions Involving Contact With Children

Answer the following questions if the position(s) for which you are applying involve(s) contact with children.
(non-program staff applicants are not required to answer these final questions about how they relate to children. Please answer N/A where an answer is required)

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:

Applicant Statement

Certification. I certify that all information provided by me to apply for work (whether as an employee or foster parent) with PCHAS is true and complete. False, misrepresented, or incomplete information of any kind will be sufficient cause for my application to be rejected or, if discovered after I begin work, cause for immediate termination.

Authorization. I authorize PCHAS to contact and obtain information about me from my previous employers, educational institutions, and references, and any other person or organization who may have information about me. I waive all rights and claims I may have against PCHAS and its representatives for seeking and using such information and all other persons or organizations for furnishing such information about me.

Discrimination. I understand that PCHAS does not unlawfully discriminate in employment, and no question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by applicable local, state, or federal law.

Conditions of Offer. I understand that any offer of work is conditional upon: (1) the results of criminal history, child abuse and neglect registry, and, if applicable, motor vehicle record searches on me; (2) the results of my pre-work drug test; (3) the results of my tuberculosis test; and (4) my presenting a valid Texas driver license within 30 days. If hired, I agree to comply with all applicable laws and all PCHAS policies and procedures. PCHAS prohibits abuse and neglect of the children and families it serves.

At-Will Status. This application is not an employment or foster parent, agreement. If I accept an offer of work, I understand that an employment or foster parent relationship with PCHAS is on an at-will basis. Accordingly, either I or PCHAS may terminate the relationship at any time, with or without notice and with or without cause. I understand that no one other than the President and Vice President for Administration has authority to enter into any agreement with terms contrary to the foregoing, and then only in writing signed by such officer.

Reapplication. I understand that this application remains current for 6 months. At the conclusion of that time, if I have not heard from PCHAS and still wish to be considered for work, I must reapply and complete a new application.

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

YES * (Must be checked for submission to work)

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