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 our understanding of the Christian mission and purpose of the organization.

Because of Sunrise's religious heritage, we honor Biblical family values as a faith-based organization. While we love and respect all people, there are times we are unable to afford employment or foster care opportunities or accept some individuals or couples because of these values. We are privileged to refer any such applicants for employment or potential foster care opportunities to other child care providers in the Commonwealth who will be a better fit for them.

As an applicant, I have read and understand the Agency’s Purpose and Expectations of Employees.

Signature of applicant* :

Date* :

As the interviewer, I have discussed the purpose and expectations of employees with the applicant during a formal interview.

Signature of Interviewer* :

Date* :

Section 2: Position Sought

Position(s) desired*

Desired work schedule*

Referred by

Section 3: Personal Summary

For Office Use Only

Name*

Phone Number*

Email*

Address*

City*

State*

Zip*

Country*

Do any of your relatives work for the agency? If yes, identify*

Are you legally eligible to work in The United States?*

Are you presently employed?*

May we contact your employer?

Are you over 21 years of age?*

What is the minimum rate of pay you expect?

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

High School Information

Name, City, State of Schools Attended*

Did you graduate?*

Major Course of Study*

Degree/Diploma*

College Information

Name, City, State of Schools Attended*

Did you graduate?*

Major Course of Study*

Degree/Diploma*

Graduate Information

Name, City, State of Schools Attended

Did you graduate?

Major Course of Study

Degree/Diploma

Technical School Information

Name, City, State of Schools Attended

Did you graduate?

Major Course of Study

Degree/Diploma

List licenses or certifications you possess

Section 5: Experience Summary

List each job held, starting with your present or most recent. If you need additional space, continue on a separate sheet

Present or Most Recent Job

Employer Name

Employer Address

Employment From Date

Employment To Date

Job Title

Duties

Supervisor Name

Supervisor Number

Reason For Leaving

Salary

Past Job #2

Employer Name

Employer Address

Employment From Date

Employment To Date

Job Title

Duties

Supervisor Name

Supervisor Number

Reason For Leaving

Salary

Past Job #3

Employer Name

Employer Address

Employment From Date

Employment To Date

Job Title

Duties

Supervisor Name

Supervisor Number

Reason For Leaving

Salary

Past Job

Employer Name

Employer Address

Employment From Date

Employment To 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

Work Related

Relationship

Reference #2

Work Related

Relationship

Reference #3

Work Related

Relationship

Reference #4

Other

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 any of the following: any felony, including but not limited to*

• An offense against a person or family
• Drug use
• Public indecency
• Any misdemeanor classified as an offense against the 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* :

In compliance with federal law, Sunrise Children’s Services does not illegally discriminate on the basis of race, sex, religion, color, national or ethnic origin, age, disability, or military service in employment. Sunrise has designated certain positions of employment as positions for which an employee’s religion is a bona fide occupational qualification. Sunrise reserves the right to hire persons for those positions who meet the requisite qualifications.

APPLICANT INFORMATION FORM

Dear Applicant:

In order for us to meet federal record keeping requirements, we request that you answer the following personal questions. This information is voluntary and refusal to provide it will not result in any adverse treatment. This information will not be used for any purpose in the employee selection process. If you have any questions about this questionnaire, please do not hesitate to ask to speak to a representative of the Human Resources Department.

PLEASE PRINT:

1. Position Desired*

Date*

2. Full Name*

3. Sex*

4. Ethnicity Origin* :

Are you Hispanic or Latino? Hispanic or Latino is defined as a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Continue with question 5 ONLY if you answer no to question 4.

5. Race and Ethnic origin*