Childcare Provider Application for Employment

Your name *

Email address *

GENERAL INFORMATION

Incomplete information could disqualify you from further consideration.

Address *

Phone number *

Please select age bracket. *

Under 18 years

18 years and up

Phone number

Are you eligible to work in the US? *

Yes

Have you ever been terminated from employment or asked to resign by an employer? *

Yes

If yes, please provide company names and details.

Please check when you are available to work: *

Sunday evenings

Wednesday mornings

Wednesday evenings

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?

Yes

How did you hear about us and/or this position? *

Have you ever worked for Hillside Community Church before? *

Yes

If yes, please provide additional explanation:

Do you know anyone who works for Hillside? *

Yes

Are you related to anyone who works for Hillside? *

Yes

Do you regularly attend our weekend services? *

Yes

If no, where do you attend church?

Have you attended the Go:Discover class?

Yes

Are you?

Weekend Attendee

Partner

Have you personally accepted Jesus Christ as your Lord and Savior?

Yes

Personal Situations

Answers to these questions will be stored in a confidential note in our system.

In the last ten years, have you ever been convicted of a crime, other than minor traffic offenses? *

If you answer 'yes' to this question, please provide details below (dates and location for all convictions). A conviction will not necessarily automatically disqualify you for employment. Rather such factors as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered.

Yes

Is there any alcohol abuse, drug abuse, physical abuse in your family background? *

If you answer yes, please list below what steps you have taken to minimize the impact that those issues will create for you, both now and in the future.

Yes

Have you ever been accused, charged or alleged to have, or have you ever committed any act of neglecting, abusing or molesting ay child/or other individual? *

If yes, explain below in detail below, providing date and place of incident.

Yes

Have you ever been concerned that you may have an addiction to drugs, alcohol, pornography or any other addiction; or has anyone ever suggested that you may have a problem with any of the above? *

If yes, please explain below.

Yes

Is there any circumstance or pattern in your life which would make it inappropriate for you to serve or would compromise the integrity of Hillside? *

If yes, please explain below.

Yes

If you answered Yes, to any of the above question under Personal Situations, please provide details below:

Answers to these details will be stored in a confidential note in our system.

Please list Name & Location of School, Years attended, Degree and Major of Study. Please include High School, College, Graduate School, if applicable. *

Date you can start: *

Please list current employer. If currently employed, may we contact your present employer?

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. *

Incomplete information could disqualify you from further consideration. You may also send a resume to childcare@yourhillside.com in place of completing this section. Please include Employer Name and phone number, Job Title, Supervisor's name, Dates of employment, Hourly Rate/Salary and reason for leaving.

List 2 Adults you've known for at least one year, who are not related to you and have a definite knowlege of your character. Please provide at least one reference that has knowledge of your ability to work with children. *

Please include name, nature of association, occupation, length of time known, address, phone number and email.

Please read carefully before signing.

Hillside Community Church (Hillside) is an equal opportunity employer. Hillside does not discriminate in employment on account of race, color, national origin, citizenship status, ancestry, age, sex, marital status, physical or mental disability, military status or unfavorable discharge from military service. Hillside is a religious organization; therefore, many of our positions do have religious belief requirements that are considered a bonafide occupational qualification.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Hillside to hire me. If I am hired, I understand that either Hillside or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Hillside has the authority to make any assurance to the contrary.

I attest with my name below that I have given to Hillside true and complete information on this application. No requested information has been concealed. I authorize Hillside to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

Childcare Provider Application for Employment

GENERAL INFORMATION

Personal Situations

Education

Employment Desired

Employment History:

References

Please read carefully before signing.

THIS APPLICATION IS VALID FOR 60 DAYS FROM THE DATE ABOVE.