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.

Statement of Faith

Without mental reservation, I hereby subscribe to Eagle Ranch's Statement of Faith below.

1. There is only one eternal, sovereign God who exists in three persons: the Father, the Son, and the Holy Spirit.
2. God created the heavens and the earth and declared His creation to be good, including humans, His prized creation created in His image.
3. All humans have sinned and live with a sin nature, which separates us from union with God and prevents us from doing good in our own strength.
4. Jesus Christ was conceived by the Holy Spirit, born of a virgin and was both fully God and fully human. He lived a sinless life and announced the arrival of God’s Kingdom and all of humanity’s invitation to be part of it. He died on a cross for the sins of the world, was raised from the dead, and lives today.
5. The only way to be forgiven of sin and made right before God is to repent of sin and believe in Jesus as Lord and Savior.
6. Those who claim Jesus as Lord and Savior by the power of the Holy Spirit will seek to live out the teachings of Jesus, summarized by the command He gave to His disciples as recorded in the Gospel of John: “Love one another. As I have loved you, so you must love one another.” As followers of Jesus, the one who gave his life away for us, we are commanded to live in sacrificial love towards others.
7. Jesus is coming one day to usher in his final and perfect Kingdom on earth. On that day, he will judge the living and the dead. All who believe and obey Jesus will be united forever with Him in the new heaven and new earth. Those who reject Jesus as Savior will experience eternal separation from God and irreversible punishment for their sin.
8. The Bible is the written Word of God and is therefore our ultimate and final authority for all matters of faith and practice.

Applicant Disclaimer*

I agree to the statement below.

The answers I have given in this application are true, accurate and complete. I understand and agree that any false statements contained herein will be sufficient cause to remove my name from consideration for employment. I further understand and agree that, if employed, any false statements given above will be sufficient cause for dismissal without any obligation or liability to me other than payment, at the agreed upon rate, for services actually rendered. I understand that this application or subsequent employment does not create a contract of employment nor guarantee employment for any definite period of time. If employed, I understand that I have been hired at the will of the employer and that my employment may be terminated at any time, with or without cause and with or without notice. I understand that no employee or representative of Eagle Ranch, other than the Executive Director, has any authority to enter into any agreement for employment for a specified period of time or to make any agreement contrary to the foregoing. Further, the Executive Director may not alter the at-will nature of the employment relationship unless done so specifically in writing.

Consent to Background Check*

I agree to a background check.

I hereby authorize Eagle Ranch and/or its agents to make an independent investigation of my background, references, character, credit history, criminal or police records, including those maintained by both public and private organizations, and all public records for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment. I release Eagle Ranch and/or its agents and any person or entity which provides information pursuant to this authorization from any and all liabilities, claims or lawsuits regarding the information obtained from any and all of the above-referenced sources used. The following is my true and complete legal name and all information is true and correct to the best of my knowledge.

Name*

First Middle Last

Other Names Used

First Middle Last