YesNo Are you at least 21 years of age?
YesNo Are you a Kentucky resident?
YesNo Do you have a valid Commonwealth of Kentucky Driver's License?
YesNo Do you have reliable transportation and automobile insurance?
YesNo Are you mentally and physically able to care for a child/children?
YesNo Do you own or rent a home that is safe and free from hazards?
YesNo Do you have space for a child or an additional child in your home?
YesNo Are you willing to complete criminal background and child abuse checks?
YesNo Are you married?
YesNo If you are married, have you been continuously married to, and living as a family with your current spouse for a minimum of one year? Co-habitating couples are not permitted.
YesNo I acknowledge that I have read and have not been convicted of any of the crimes listed on the KRS reference sheet. Please Note: If any of these statues are found to be true you forego your initial Home Study application fee.
Your Full Name (required)
Home Address (required)
Zip Code (required)
Home Phone Number (required)
Work Phone Number
Your Email (required)
How did you hear about us? (required)
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A Kentucky child abuse or neglect check conducted by the cabinet shall identify the name of each applicant, adolescent member of the household, or adult member of the household who has been found by the cabinet to have:
Committed sexual abuse or sexual exploitation of a child;
Been responsible for a child fatality related to abuse or neglect;
Abused or neglected a child within the seven (7) year period immediately prior to the application; or
Had parental rights terminated.
An applicant shall not be approved if:
A criminal records check reveals that the applicant, or adult member of the household, has a:
Felony conviction involving:
A spouse, a child, sexual violence, or death as described by 42 U.S.C. 671(a)(20); or
Physical abuse, battery, a drug, or alcohol within the five (5) year period prior to application;
Criminal conviction relating to child abuse or neglect; or
Civil judicial determination related to child abuse or neglect;
A child abuse or neglect check reveals that the applicant, adolescent member of the household, or adult member of the household, has been found to have:
Been responsible for a child fatality related to abuse or neglect; or
Had parental rights terminated involuntarily in accordance with KRS 625.050 through 625.120 or another state’s laws; or
An address check of the Sex Offender Registry and supporting documentation confirm that a sex offender resides at the applicant’s home address.
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: 1) interferes with Sunrise’s pursuit of its Christian mission and purpose; 2) fails to exhibit a regard for the rights of others; or 3) 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 (required)
Section 2: Position Sought
Position(s) desired: (required)
Desired Work Schedule: (required)
Referred by: (required)
Section 3: Personal Summary
Phone Number: (required)
If you have any relative that work for the agency please specify: (required)
Are you legally eligible to work in the United States: (required)
Are you presently employed? (required)
If yes, may we contact your employer? (required)
Are you over 21 years of age? (required)
What is the minimum rate of pay you expect? (required)
Section 4: Education Summary
Note: Proof of education is required for employment.
List licenses or certifications you possess:
Section 5: Experience Summary
List each job held, starting with you present or most recent. If you need additional space, continue on a separate sheet.
Employer Name & Address:
Reason for Leaving:
List special skills you possess:
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.
Section 7: Additional Questions
The information requested below is needed for a legally permissible reason including, but no limited to: licensure considerations, a legitimate occupational qualification, or 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, or public indecency; or any misdemeanor classified as an offense against the person or family? (required)
If yes, explain fully:
Are you subject to any pending criminal charges? (required)
Do you have a valid driver's license? (required)
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: (required)
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
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.
1.) Position Desired: (required)
2.) Full Name: (required)
4.) Ethnicity Origin: (required)
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 answered "no" to question 4
5.) Race and Ethnic origin
---White (not Hispanic origin): Persons having origins in any of the original peoples of North Africa, Europe, or the Middle EastBlack/African American: Persons having origins in any of the Black racial groups of AfricaAsian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and VietnamNative Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other pacific islandsAmerican Indian or Alaskan: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific islandsTwo or more races: All persons who identify with more than one of the above five races