Employment Application - United Methodist Community House

GENERAL INFORMATION

Name:*

First

Last

E-mail:*

Phone:*

Area Code

-

Phone Number

Address:*

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeCountry

Are you a United States Citizen?*

Yes

No

What position are you applying for?

Availablity*

When are you available to start?*

/

day

month

year

Minimum Salary*

Have you applied at UMCH before?*

Yes

No

How did you hear about this job opportunity?*

Would you be willing to undergo drug testing?

Yes

No

Have you ever been convicted of a crime?

Yes

No

Have you ever been convicted of child abuse or neglect?

Yes

No

EDUCATION

Select the level of education you have completed.*

Please provide the name and address of the school, college, or university.*

Dates you attended:*

Degree or Title Earned

Field of Study

Please provide the name and address of the school, college, or university you attended previously.

Dates you attended this school.

Degree or Title Earned at This School

Are you a liscensed/registered member of any trade or profession?*

Yes

No

EMPLOYMENT HISTORY

Current Employer

Name of Current Supervisor

Phone Number of Current Employer

Area Code

-

Phone Number

E-mail of your current employer

Your current job title

Current job responsibilties

Date range of current job - 00/00 - 00/00

Starting Salary

Current or Ending Salary

Why are you seeking other employment?

May we contact your current employer?

Yes

No

May we contact you at your current job?

Yes

No

Previous Employer #1

Name of Previous Supervisor #1

Phone Number of Previous Employer #1

Area Code

-

Phone Number

E-mail of Previous Employer #1

Job Title, Previous Employer #1

Job Responsiblities - Previous Employer #1

Date Range of Previous Employer #1 - 00/00-00/00

Starting Salary of Previous Employer #1

Ending Salary of Previous Employer #1

May we contact Previous Employer #1?

Yes

No

Previous Employer #2

Name of Supervisor Previous Employer #2

Phone Number for Previous Employer #2

E-mail of Previous Employer #2

Job Title for Previous Employer #2

Job Responsiblities for Previous Employer #2

Date Range for Previous Employer #2 - 00/00

Starting Salary for Previous Job #2

Ending Salary for Previous Job #2

May we contact Previous Employer #2?

Yes

No

ADDITIONAL SKILLS

Please provide information regarding your skills related to the position in which you are applying. Include information on internships and/or volunteer activities.*

REFERENCES

Name of first reference*

Relationship of first reference*

Phone number of first reference*

Area Code

-

Phone Number

E-mail of first reference

Name of second reference*

Relationship of second reference.*

Phone number of second reference.*

Area Code

-

Phone Number

Email of second reference

Name of third reference.*

Relationship of third reference.*

Phone number of third reference.

Area Code

-

Phone Number

Email of third reference.

ETHICAL BEHAVIOR STANDARDS
As an employee with the UMCH, you will not:
1) Participate in sexual activity with any minor program participant whether consensual or non‐consensual.
2) Strike or otherwise physically restrain or restrict the movement of program participants unless essential for their safety and protection. You will notify your supervisor in the latter case.
3) Release any confidential information without permission to do so.
4) Provide program participants with any forms of drugs, legal or illegal, unless authorized to do so.
5) Misrepresent your credentials and provide services that you are not qualified or authorized to provide.
7) Be alone with a single child in an isolated situation where you cannot be observed by other staff and children. The only exception to this would be toileting or medical emergencies, in which case another staff
person should be notified.

Violations of the above will result in an immediate suspension. Should the allegations be substantiated, permanent removal from the volunteer program will result. Should your behavior be illegal, proper authorities will be notified.

HARASSMENT POLICY
It is the policy of the United Methodist Community House to expressly forbid any forms of harassment. The term "harassment" includes, but is not limited to: slurs, jokes, or other verbal, graphic, or physical conduct which relates to an individual's race, color, sex, religion, nation origin, citizenship, age, or handicap. Harassment also includes unwanted sexual advances, requests for sexual favors, unwelcome or offensive touching, or other verbal, graphic, or physical conduct of a sexual nature.

Employees who feel they are being harassed in any way by an employee, member, vendor, or volunteer should inform their immediate supervisor or the CEO. It is the individual's responsibility to bring such concerns to the proper person. Any and all concerns will be handled immediately and kept confidential.

PHOTO/VIDEO WAIVER
I give my permission to the United Methodist Community House to use, without limitation or obligation, photographs, film footage, or tape recordings which may include my image or voice for purposes of promoting the organization and its programs.

Signature - please type in your name.*

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