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Thank you for your interest in becoming a staff member of Sunrise Children’s Services. Please review the information and answer the questions below to help us in evaluating you as a potential employee.

Section 1: Agency’s Purpose And Expectations Of Employees

Sunrise Children’s Services is a ministry operated under the direction of a board of directors elected by the Kentucky Baptist Convention. Our mission is to provide care and hope for hurting families and children through christ-centered ministries. Every employee is a role model for the children and families under Sunrise Children’s Services care, therefore, employees are expected to exhibit values in their professional conduct and personal lifestyles that are consistent with the christian mission and purpose of the institution. Sunrise Children’s Services prohibits personal behavior which:

  • Interferes with Sunrise’s pursuit of its christian mission and purpose
  • Fails to exhibit a regard for the rights of others
  • Shows disrespect for the safety of persons and property.

As an applicant, I have read and understand the agency's purpose and expectations of employees.

Signature of applicant

Date

Section 2: Position Sought

Position desired

Desired work schedule

Referred by

Section 3: Personal Summary

Name

Phone Number

Email

Address

City

State

Zip Code

Country

If you have a relative that works for the agency please specify

Are you legally eligible to work in The United States

Are you currently employed?

May we contact your employer?

Are you over 21 years of age?

What is the minimum rate of pay that you expect?

Section 4: Education Summary
Note: Proof of education is required for employment

High School Information

High School

Name, City, State of Schools Attended

Did you graduate?

Major Course of Study

College Information

College

Name, City, State of Schools Attended

Did you graduate?

Major Course of Study

Graduate Information

Graduate Information

Name, City, State of Schools Attended

Did you graduate?

Major Course of Study

Technical School Information

Technical School

Name, City, State of Schools Attended

Did you graduate?

Major Course of Study

Section 5: Experience Summary

List each job held, starting with you present or most recent.

Present or Most Recent Job

Employer Name

Employer Address

Employer Date

Job Title

Duties

Supervisor Name

Supervisor Number

Reason For Leaving

Salary

Past Job #2

Employer Name

Employer Address

Employer Date

Job Title

Duties

Supervisor Name

Supervisor Number

Reason For Leaving

Salary

Past Job #3

Employer Name

Employer Address

Employer Date

Job Title

Duties

Supervisor Name

Supervisor Number

Reason For Leaving

Salary

Past Job

Employer Name

Employer Address

Employer Date

Job Title

Duties

Supervisor Name

Supervisor Number

Reason For Leaving

Salary

List Special Skills you posses:

Identify computer programs and/or office equipment you can operate:

Section 6: References

List three work-related references and one other reference with address and telephone number

Reference #1

Name

Phone Number

Relationship

Reference #2

Name

Phone Number

Relationship

Reference #3

Name

Phone Number

Relationship

Reference #4

Name

Phone Number

Relationship

Section 7: Additional Questions

The information requested below is needed for a legally permissible reason including, but not limited to:

  • Licensure considerations
  • A legitimate occupational qualification
  • Business necessity

Have you been convicted of a felony, including but not limited to any of the following:

  • An offense against a person or family
  • Drug abuse
  • Public indecency
  • Any misdemeanor classified as an offense against a person or family

If Yes, explain fully

Are you subject to any pending criminal charges?

If Yes, explain fully

Do you have a valid drivers license?

Section 8: Release Authorization and Certification
Please read the following section carefully before signing!

For this type of employment, State Law requires a criminal background check as a condition of employment.

I authorize Sunrise Children’s Services, inc. to conduct any investigation it deems necessary with respect to information supplied above. i authorize any former employer, present employer, school, college, university, credit or finance bureau, personal reference and/or any other person to give any information they may have concerning my employment, character, health or credit. I hereby unconditionally release from liability for any damage, whether caused directly or indirectly from giving or receiving this information or opinions, Sunrise Children’s Services, inc. and any informant contacted whether named or unnamed.

I understand that no contract of employment and no promise of employment for a definite period of time, whether express or implied, shall be effective or binding on sunrise unless expressly set forth in a separate written document and signed by the president of sunrise.

I understand that if employed, I will be required to follow the personnel policies and rules of the institution and that infractions of such rules may lead to my discharge. in the event of employment, I understand that any false or misleading information given on this information sheet or in an interview may result in discharge and that, as an employee, I will be subject to a post-offer employment drug screen

I understand that if employed, I will be required to follow the procedures set forth in sunrise’s dispute resolution plan, instead of court proceedings, to address any legal claims I may have arising out of my employment. By accepting employment with sunrise, I willingly agree to waive any right I would otherwise have to a jury trial on such legal claims.

Signature of Applicant

Date

The (PRE-OFFER)

INVITATION FOR INCLUSION UNDER AFFIRMATIVE ACTION PROGRAMS FOR PROTECTED VETERANS

Sunrise is a Government contractor subject to the Vietnam Era Veteran's Readjustment Assistance Act of 1974 (VEVRAA),

as amended by the Jobs for Veterans Act of 2002,38 U.S.C. 4212 {VEVRAA), which requires such Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. DEFINITIONS: A "disabled veteran" is defined as (1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secret Jry of Veterans Affairs, or (2) A person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" is defined as any veteran during the three-year period beginning on the U.S. military, ground, naval or air service.

An active duty wartime or campaign badge veteran" means a veteran who served on active duty In the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed Forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

If you believe that you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below. As a government contractor subject to VEVRAA,we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

SUBMISSION OF THIS INFORMATION IS VOLUNTARY and refusal to provide it will not subject you to discharge, discipline, or any other adverse treatment. You may Inform us of your desire to benefit under the affirmative action program now or at any time In the future. This information shall be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions of the work duties of individuals with disabilities or special disabled veterans and/or regarding necessary accommodations,(ii) first aid and safety personnel may be informed, when and to the extent appropriate, If the condition might require emergency treatment, Jnd {iii) Government officials engaged in enforcing VEVRAA may be informed. The Information provided will be used only in ways that are consistent with Section 503 of the Rehabilitation Act, VEVRM, and the ADA.

I identify as one or more of the classifications of protected veteran listed above.

I am not protected veteran.

I do not wish to answer.

I HAVE READ THE ABOVE AND VOLUNTARILY SUBMIT THIS INFORMATION.

Date

Name

Signature