New Life Children's Home

“Where GOD Is Changing Lives”

Office - P.O. Box 885, Newport, AR.  72112
Phone (870)-523-8413 or 870-217-1372
Fax (870)-217-0912 
E-Mail – projnewstart@yahoo.com

Website - www.projectnewstart.org






 

New Life Church

New Life Children’s Home

Moral Turpitude Clause

 

As a faith based entity, the New Life Children’s Home, (NLCH), holds core values
that are adherent to our program of services and our faith tradition.  These are 
set forward in the New Life Church by-laws.  Any serious act of misconduct
or violation of these moral values by an Employee, including (but not limited to)
an act of dishonesty, theft or misappropriation of NLCH property,
moral turpitude, insubordination, or any act injuring, abusing, or
endangering others. Any misconduct which may, in the sole judgment of the
NLCH Administrator and Project New Start Board of Directors,  reflect
adversely upon the ministry or its programs.  Any conduct of the employee
seriously prejudicial to the best interest of the NLCH or its program or which
violates  the Ministries mission are grounds for immediate
termination of the employee’s services. The employee shall have the right to
appeal the decision of the Project New Start Board of Directors to the Project
New Start Board of Directors within 10 days of termination. The decision of
the Appeal Board shall be final. 



Application for Employment


Please Print

                                                                                                             Date: ____________________

 

PERSONAL INFORMATION

 

(Last)

 

Name:

(First)

(Middle)

Street Address:

 

Home Telephone Number:

Cell Phone Number:

City

State

Zip

Social Security Number:

Email Address:

Date of birth:

 

 

 

Position Applying For: __________________________________________

                                          ______volunteer                                 _____paid position

 

Are you legally eligible for employment in the United States?     Yes    No

Are you at least 21 years of age?     Yes     No

Do you have any physical limitations that would hinder you from performing your duties?     Yes   No
Do you drink alcoholic beverages?     Yes     No

Do you use tobacco products?     Yes     No

Are you currently on any type of medication?     Yes    No
If so, list all medications below:
____________________________________________________________________________________
____________________________________________________________________________________
Do you have a current driver’s license?      Yes     No

If yes, complete the following:

Driver’s Licenses Number: _________________________________   Issuing State:  __________________

Have you been convicted of a traffic offense in the past five (5) years?     Yes    No

If yes, give the nature of the offense, the name and location of the court and the penalty or disposition of the case:

____________________________________________________________________________________
____________________________________________________________________________________

Marital Status:       Single        Engaged        Married     
Date of Marriage: _________________________
Please list the names and ages of your children and whether they are living with you.            Child's Name                                 Age                                Lives with you?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 





EDUCATION

 

School name

Location

Years Attended

Did you graduate?

Degree or Diploma?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please list additional job-related seminars, courses, workshops, or other educational experiences:

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

Please list additional job-related experience, special training, specialized licensing, special skills, or noteworthy achievements:

________________________________________________________________________________________________

________________________________________________________________________________________________
________________________________________________________________________________________________

 

· A spouse of a hired house parent can get an outside job but is required to work 15 hours a week toward free rent and food at (NLCH). All house parents and spouses must attend all mandatory meetings. Program Director must have either verbal or written notification from spouse or houseparent to miss mandatory meetings. Program Director must approve your  request. Any house parent or spouse that has three write ups within 30 days will be terminated. A clean slate will start thirty days
from last write up.

 
EMPLOYMENT RECORD

(Please give accurate, complete information for the past five full-time and part-time employers,
including any military service.  Start with your present or most recent employer.)

 


Employer: _______________________________________ Phone Number: _______________________

Address: _______________________________________________  Zip Code ____________________

Job Title(s): _______________________________  Immediate Supervisor:_______________________

Description of your work: _______________________________________________________________

Reason for leaving: ____________________________________________________________________

__________________________________________________________________________________

Employed from _____/______/______ to _____/______/______

Salary: Starting ___________ Final ____________

*****************************************************

Employer: _______________________________________ Phone Number: ______________________

Address: _______________________________________________  Zip Code ___________________

Job Title(s): _______________________________  Immediate Supervisor:______________________

Description of your work: ______________________________________________________________

Reason for leaving: ___________________________________________________________________

__________________________________________________________________________________

Employed from _____/______/______ to _____/______/______

Salary: Starting ___________ Final ____________

*****************************************************
Employer: _______________________________________ Phone Number: _______________________

Address: _______________________________________________  Zip Code _____________________

Job Title(s): _______________________________  Immediate Supervisor:_______________________

Description of your work: _______________________________________________________________

Reason for leaving: ____________________________________________________________________

__________________________________________________________________________________

Employed from _____/______/______ to _____/______/______

Salary: Starting ___________ Final ____________

*****************************************************

Employer: _______________________________________ Phone Number: ______________________

Address: _______________________________________________  Zip Code ____________________

Job Title(s): _______________________________  Immediate Supervisor:_______________________

Description of your work: _______________________________________________________________

Reason for leaving: ____________________________________________________________________

__________________________________________________________________________________

Employed from _____/______/______ to _____/______/______

Salary: Starting ___________ Final ____________

Have you ever worked under a different name for any of these employers?   Yes       No
If yes, please identify the employer and state the different name:
________________________________________________________

CRIMINAL RECORD
Have you ever been convicted of child abuse or a crime involving actual or attempted sexual molestation of a minor?  Yes       No
If yes, please give the nature of the offense, the name and location of the court and the penalty or disposition of the case(s) and name of probation officer if you are now on probation.
________________________________________________________
________________________________________________________

Have you ever been convicted of a crime, including misdemeanors and summary offenses, which has not been annulled, expunged or sealed by a court?  Yes      No
If yes, please give the nature of the offense, the name and location of the court and the penalty or disposition of the cases(s) and name of probation officer if you are now on probation.
________________________________________________________
________________________________________________________

AUTHORIZATION FOR DRUG/ALCOHOL SCREENING
As an applicant and potential new employee for New Life Children's Home, do you consent to a pre-employment drug/alcohol screen? 
Yes     No
It is the practice of New Life Children's Home to provide frequent drug/alcohol screenings to employees.
Do you consent to drug/alcohol screens if employed and required to do so?  Yes    No


The answers given by me on this application are true and correct to the best of my knowledge and any misrepresentations will be cause for my rejection or dismissal. I agree to follow the policies and procedures of New Life Children’s Home which I understand will change from time to time.

IF I AM EMPLOYED BY NEW LIFE CHILDREN‘S HOME,

I UNDERSTAND THAT MY EMPLOYMENT WILL BE ON AN AT-WILL BASIS.

 

 

_____________________________________                                      __________________

Signature                                                                                     Date

 

REFERENCES

List three references including your current pastor and current or former employer.

No relatives, please.

 

     Name:  _______________________________________________________

     Address:  _____________________________________________________     
     Phone:  __________________

     Useful Information:
_________________________________________________________________

 

     Name:  _______________________________________________________

     Address:  _____________________________________________________
     Phone:  __________________

     Useful Information:  _________________________________________________________________

 

     Pastor's Name:  ________________________________________________

     Address:  _____________________________________________________    
     Phone:  __________________

     Useful Information:  _________________________________________________________________

 

I authorize the New Life Children’s Home (NLCH) program director to make any inquiry or engage in any discussion concerning me which is deemed appropriate to determine my suitability for employment.  I authorize the program director to share relevant information with the NLCH Board of Directors during consideration for employment.

 

I also ask the person, firm or company to which or to whom inquiry is made to fully reveal information, records, or other materials which may pertain to me. I authorize the release of this information without liability to any person, firm, or company releasing such information.

 

 

___________________________                                                        ____________________

Signature                                                                                       Date