ADM-003 Employment Application Part 1 of 2

CHRISTIAN HOMES & FAMILY SERVICES

Welcome to Christian Homes & Family Services employment application area. We welcome you to complete an application for employment. Thank you for your interest in working for the Christian Homes' ministry. This is Part 1 of a two part form.

If you are starting the application for the first time, please click "NO" below to begin completing the employment application. Â If you previously started the application, please click on "Yes" and enter the password that you created when you began the application. Â This will allow you to access to the previously entered information so that you will be able to continue the application. Â We appreciate your interest in employment with Christian Homes & Family Services.

Yes, Login

No, Begin Form

Position(s) for which you are applying
Check the position(s) for which you believe you are qualified and for which you are applying.
Position(s) Applying For	Support: Maintenance; Receptionist, Clerk, Secretary, Bookkeeper, Case Aid Caseworker - Adoption; Foster Care; Maternity Program Director - Adoption; Foster Care; Maternity Development/Fund Raising/Church Relations Public Relations/Marketing Administration: Office Manager; Business Manager; Vice Pres.; President
Check the position(s) for which you believe you are qualified and for which you are applying.
Staff Office Location	Abilene, TX Ft. Worth, TX Tyler, TX

Prospective Employee Information

*Driver's License Number

Enter your driver's license number

*State Issuing DL

Enter Region

Select the two letter abbreviation of the state issuing the driver's license

Name Prefix

*First Name*

*Middle Name

*Maiden Name

*Last Name

*Other names/nick names you may have used

*Gender

*Race

Please indicate your race

*Ethnicity

Indicate your ethnicity(ies)

Marital Status

Indicate your marital status

Religious Preference

Indicate your religious preference

*Date of Birth

Residence Address

Street Address

Street Address Line 2

Street Address Line 3

City

State/Region

Enter Region

Zip Code

Prior Addresses
*List all other cities in Texas where you have lived
*If you have lived outside of Texas in the previous 5 years, you must also list previous address(es) outside of Texas, including the county(ies)

Telephone Numbers & Email Addresses

Home Phone Number

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Enter Int'l Number

Cell Phone Number

()-ext

Enter Int'l Number

Work Phone

()-ext

Enter Int'l Number

Fax Number

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Enter Int'l Number

Home Email

Work Email

Physical Examination/Testing
Dependent upon the position for which you are applying, a physical examination may be required as well as testing for communicable diseases.
If so, are you willing to have an examination/testing and provide the results to the Agency at your expense	YesNo
Do you smoke	YesNo

Criminal Conviction(s)
The Texas Department of Human Services, Minimum Standards for Child Placing Agencies, Section 2200, Paragraphs 1 and 2b require the following statement be signed and that Christian Homes & Family Services check the criminal records of prospective employees.
Have you had felony or misdemeanor conviction(s)	YesNo
Indicate if you have felony or misdemeanor conviction(s)
If yes, please explain
Please provide the details regarding each conviction, i.e. date, city, county, state, nature of the charges & conviction, whether felony or misdemeanor, etc
Are criminal charges PENDING against you at the present time for any misdemeanor or felony classed as an offense against the person or family, or of public indecency, or of violation of the Texas Controlled Substances Act	YesNo
Indicate yes or no
If yes, please explain

Current or Most Recent Employer

Present or most recent employer

May we contact your present employer about this application

YesNo

Enter the name of your current company/employer

Enter type of Business

Enter Company Street Address

Enter Company Street Address-line 2

Enter city in which your company is located

Select the state in which your company is located

Enter Region

Enter the company's zip code

Enter the company's business phone (including area code)

()-ext

Enter Int'l Number

Enter your supervisor's first and last name

Enter your supervisor's title

Explain why you left or are leaving the company

Enter the date you started work for this company

Enter your starting annual salary

Describe the job for which you were hired

Enter date that you left this job. Leave blank if you work for this employer.

Enter the salary you were earning when you left your most recent position or that you are now earning

Describe the job you were performing when you left the company.

If you are still employed describe your current position. If you are in the same position as when you started for the company, just enter "same" since you described that position earlier

Previous Employer

Enter the name of your previous employer

Enter type of business

Enter previous employer's street address

Enter previous employer's street address - line 2

Enter city in which your previous employer is located

Select the state in which your previous employer is located

Enter Region

Enter previous employer's zip code

Enter previous employer's business phone

()-ext

Enter Int'l Number

Enter your previous supervisor's first and last name

Enter your supervisor's title

Explain why you left this employer

Enter the date you started work for this employer

Enter your starting annual salary

Describe the job for which you were hired

Enter date that you left this job

Enter the salary you were earning when you left this position

Describe the job you were performing when you left this position

When you click on the Submit button, you will be taken to Part 2 of the Employment Application.

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Christian Homes and Family Services | P.O. Box 270 | Abilene, TX 79604