Counselor Employment Application

Position*

Please choose the position for which you want to apply.

Date*

Personal Information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Daytime Phone

Type*

Home

Cell

Work

Email*

Staff working with children must be 21 or older; all other staff must be at least 18. Do you meet this requirement?*

Yes

No

Are you a U.S. citizen or otherwise eligible to work in the U.S.?*

Yes

No

Emergency Contact*

First Last

Relationship*

Phone*

If hired, on what date could you begin work?*

How did you hear about this position?*

(Please be specific)

Education

High School*

Name

Location

Did you Graduate?

College/University

Name

Location

Diploma/Degree

Major/Minor

Did you Graduate?

Trade, Business or Correspondence School

Name

Location

Diploma/Degree

Did you Graduate?

Professional Certificates or Licenses held:

Subjects or special studies:

Extracurricular activities:

Have you had any special education or training in residential group child care and/or child welfare?*

Yes

No

If yes, please explain:

Other Information

Have you ever been convicted, pled guilty, or pled “no contest” or “nolo contendre” to a criminal offense (other than a minor traffic violation), including sex-related or child-abuse related offenses? If yes, give date, offense, court and sentence:*

Yes

No

If yes, give date, offense, court and sentence:

Is there any reason why you might be unable to perform the duties of the position for which you are applying?*

Yes

No

If so, please explain:

Employment History

PLEASE COMPLETE THIS SECTION EVEN IF INCLUDED ON A RESUME. List employment status for the last ten (10) years. Start with most recent. Account for all periods of time including schooling, military service, and/or periods of unemployment and explanation.

Previous employer

Position/Title

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor's Name

First Last

Supervisor's Phone

Date Employed

Date Left

Beginning Salary*

Ending Salary*

Responsibilities:

Reason for Leaving:

Please explain any lapse of time between this employer and previous if applicable:

Previous employer

Position/Title

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor's Name

First Last

Supervisor's Phone

Date Employed

Date Left

Beginning Salary

Ending Salary

Responsibilities:

Reason for Leaving:

Please explain any lapse of time between this employer and previous if applicable:

Previous employer

Position/Title

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor's Name

First Last

Supervisor's Phone

Date Employed

Date Left

Beginning Salary

Ending Salary

Responsibilities

Reason for Leaving

Please explain any lapse of time between this employer and previous if applicable:

Previous Employer

Position/Title

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor's Name

First Last

Supervisor's Phone

Date Employed

Date Left

Beginning Salary

Ending Salary

Responsibilities:

Reason for Leaving:

Please explain any lapse of time between this employer and previous if applicable:

Previous Employer

Position/Title

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor's Name

First Last

Supervisor's Phone

Date Employed

Date Left

Beginning Salary

Ending Salary

Responsibilities:

Reason for Leaving:

Please explain any lapse of time between this employer and previous if applicable:

Previous Employer

Position/Title

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor's Name

First Last

Supervisor's Phone

Date Employed

Date Left

Beginning Salary

Ending Salary

Responsibilities:

Reason for Leaving:

Please explain any lapse of time between this employer and previous if applicable:

COUNSELING PHILOSOPHY

Briefly explain your theoretical philosophy in counseling and how that applies to the treatment of families. Describe how past therapeutic experiences have influenced your thoughts on the treatment of families.*

Briefly explain any experience you have in management and describe your management “style.”*

REFERENCES

Please list below 5 references (professional, educational, or personal).

Reference 1*

First Last

Company/Title*

Phone*

Years Known*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference 2*

First Last

Company/Title*

Phone*

Years Known*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference 3*

First Last

Company/Title*

Phone*

Years Known*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference 4*

First Last

Company/Title*

Phone*

Years Known*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference 5*

First Last

Company/Title*

Phone*

Years Known*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

More About You

Please explain why you want to work at Eagle Ranch.*

Please tell us about your family.*

Please tell us about your extracurricular or community activities, hobbies and interests, special skills or talents.*

Please provide any additional information about yourself which will aid in evaluating your interest and qualifications for employment at Eagle Ranch.*

Statement of Applicant's Christian Faith

Due to the unique nature and purpose of Eagle Ranch, it is important that our employees be committed to the Christian principles as explained in our Statement of Faith. All of our employees are involved in times of prayer for our children, their families, and the ministry. They also actively participate in devotions and Ranch-wide chapel services. To help us evaluate our compatibility, please take a moment to answer the following.

Name of church you presently attend:*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Pastor's Name:*

First Last

Pastor's Office Phone*

Number of Yrs. Attending*

Tell us about your spiritual walk with the Lord.*

Eagle Ranch Statement of Faith & Consent

Eagle Ranch certifies that all reports, whether oral or written, will be kept strictly confidential and, except as required by law, information will only be revealed to the applicant or person whose duty requires him or her to participate in the decision for the transaction for which the report was ordered. Eagle Ranch further certifies that the purpose of the investigation is very limited in scope and information received will be used for the sole purpose of making a determination regarding the qualifications of an individual for employment purposes, which term includes initial employment, promotion, reassignment, or retention as an employee.

Name*

First Middle Last

Other Names Used

First Middle Last