Hope Ranch

Star Meadows Academy

1005 Baker Avenue Suite G, Whitefish, MT 59937

Application for Employment

Hope Ranch/Star Meadows Academy Is An Equal Opportunity Employer

What type of position(s) are you applying for?

Full Time	Volunteer	Temporary (Less than one year)
Part Time	Internship

Last Name First Name Middle Name

Mailing Address City State Zip

Street Address (if different from above)

Social Security Number Telephone Number(s) – Day Time:

Evening:

E-mail address

Place of Birth

Position(s) Applied For: Date

How Did You Learn About Us?

1.	Are you available for an immediate assignment? If “No” – please provide the date you will be available:	Yes ___________	No
2.	Are you presently employed?	Yes	No
3.	May we contact your present employer?	Yes	No
4.	Are you able to work varying shifts?	Yes	No

5.	Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment)	Yes	No
6.	Have you ever filed an application with us before?	Yes	No
7.	Have you ever worked for Hope Ranch or Cunningham Christian Youth Village before?	Yes	No
8.	Have you ever been convicted of any offense, including motor vehicle violations? (Conviction will not necessarily disqualify an applicant from employment)	Yes	No
	If “Yes” – please provide charges convicted of, date of conviction, city, state and court of conviction, and a brief description of the circumstances: ___________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________
9.	Have you ever been convicted of any offense involving child abuse or any type of sexual offense?	Yes	No
	If “Yes” – please provide charges convicted of, date of conviction, city, state and court of conviction, and a brief description of the circumstances: ___________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________

EDUCATION

	High School	College/University	Graduate/Professional
School Name and Location
Years Completed
Diploma/Degree
Describe Course of Study

Describe any specialized training, apprenticeships, skills, and extra-curricular activities: _____________

____________________________________________________________________________________

Describe any honors you received: _______________________________________________________

____________________________________________________________________________________

State any additional information you feel may be helpful to us in considering your application: _________

____________________________________________________________________________________

List any professional, trade, business, or civic organizations or activities for which you have been a member and indicate any offices held: ____________________________________________________

____________________________________________________________________________________

EMPLOYMENT EXPERIENCE

Employer		Dates Employed
		To: _________	From: _________
Address	Work Performed
Telephone Number(s)
Job Title	Supervisor
Reason For Leaving

Employer		Dates Employed
		To: _________	From: _________
Address	Work Performed
Telephone Number(s)
Job Title	Supervisor
Reason For Leaving

Employer		Dates Employed
		To: _________	From: _________
Address	Work Performed
Telephone Number(s)
Job Title	Supervisor
Reason For Leaving

Employer		Dates Employed
		To: _________	From: _________
Address	Work Performed
Telephone Number(s)
Job Title	Supervisor
Reason For Leaving

Þ Please continue on a separate sheet of paper if additional space is required

Summarize special job-related skills and qualifications acquired from employment or other experience.

____________________________________________________________________________________

REFERENCES

Please proved the name, address, and telephone number of three (3) references who are not related to you and who are not previous employers, but know of your qualifications and calling to work at Hope Ranch/Star Meadows Academy.

1. _________________________________________________________________________________

_______________________________________________________________________________

2. _________________________________________________________________________________

_______________________________________________________________________________

3. _________________________________________________________________________________

_______________________________________________________________________________

APPLICANT’S STATEMENT

I certify that the answers and information herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment, as a paid or volunteer employee, as may be necessary in arriving at an employment decision. This will include a criminal history inquiry and an inquiry with Child Protective Services.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate discharge. I understand, also, that I am required to abide by all rules and regulations of Hope Ranch/Star Meadows Academy.

_____________________________________ ______________

Signature of Applicant Date

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FOR OFFICE USE

Interview Notes: ______________________________________________________________________

____________________________________________________________________________________

Interviewed by: _______________________________________________ Date: _____________

Hire Approval by: _____________________________________________ Date: ______________

Date of Hire: _____________________

RELEASE

Criminal Records Background Check

For Prospective Employment

Date: _________________________

TO: Criminal History Records (OR) Department of Justice

Criminal History Records

State of: _________________ Scott Hart Building, Room 374

303 North Roberts

County of:________________ Helena, MT 59620-1418

FAX (406) 444-0689

FROM: (AGENT) (FOR) (EMPLOYER)

Moonlighting Detective Agency HOPE RANCH/STAR MEADOWS ACADEMY

695 First Avenue WN 1005 Baker Avenue Suite G

Kalispell, MT 59901 Whitefish, MT 59937-4841

FAX: (406) 752-1017

RE: Criminal Background Check

NAME: ____________________________________________________ SS#: __________________

DOB: ____________________________

Other names used: ___________________________________________________________________

Cities and state lived in and dates of residency since reaching the age of 18:

____________________________________________________________________________________

Þ Please Note: Any deletions or oversights may result in the denial of your application.

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I hereby authorize any law enforcement agency to release any public and/or non-public records they have regarding me to: Steel Mountain Investigations on behalf of Hope Ranch/Star Meadows Academy. I understand that any information obtained from this check will be used by Hope Ranch/Star Meadows Academy to determine my eligibility for employment. A copy of this form is as valid as the original.

____________________________________________________ ___________________________

Signature of prospective employee Date

Subscribed and sworn to before me this __________ day of _________________________, ________

______________________________________

Notary Public

(NOTARIAL SEAL)

Residing at: ____________________________

My commission expires: __________________

RELEASE

CPS Record Check

For Prospective Employment

Date: _________________________

TO: Child Protective Services

State of: ____________________

County of:___________________

FROM: (AGENT) (FOR) (EMPLOYER)

Moonlighting Detective Agency HOPE RANCH/STAR MEADOWS ACADEMY

695 First Avenue WN 1005 Baker Avenue Suite G

Kalispell, MT 59901 Whitefish, MT 59937

FAX: (406) 752-1017

RE: Child Protective Services Records Check

NAME: ____________________________________________________ SS#: __________________

DOB: ____________________________

Other names used: ___________________________________________________________________

Cities and state lived in and dates of residency since reaching the age of 18:

____________________________________________________________________________________

Do you have any comments or concerns regarding this CPS Record Check?

____________________________________________________________________________________

================================================================================

Does this person(s) have a CPS record? ______ YES _______ NO

================================================================================

I hereby authorize any Child Protective Service’s Agency to conduct a background check through the state(s) of __________________________________________________ and inform Steel Mountain Investigations on behalf of Hope Ranch/Star Meadows Academy if I have any substantiated referrals of child abuse or neglect against me.

____________________________________________________ ___________________________

Signature of prospective employee Date

Subscribed and sworn to before me this __________ day of _________________________, ________

______________________________________

Notary Public

(NOTARIAL SEAL)

Residing at: ____________________________

My commission expires: __________________