CIRCLE Y RANCH
Employment Application
APPLICANT INFORMATION
Last Name
First
M.I.
Street Address
Date
Apartment/Unit #
City
State
Phone
E-mail Address
Date Available
ZIP
Social Security No.
Desired Salary
Position Applied for
Are you a citizen of the United States?
YES
NO
If no, are you authorized to work in the U.S.?
Have you ever worked for this company?
YES
NO
If so, when?
Have you ever been convicted of a felony?
YES
NO
If yes, explain
EDUCATION
High School
From
Address
To
Did you graduate?
College
From
NO
Degree
NO
Degree
NO
Degree
Address
To
Did you graduate?
Other
From
YES
YES
Address
To
Did you graduate?
YES
REFERENCES
Please list three professional references.
Full Name
Relationship
Company
Phone
Address
Full Name
Relationship
Company
Phone
Address
Full Name
Relationship
Company
Phone
Address
YES
NO
PREVIOUS EMPLOYMENT
Company
Phone
Address
Supervisor
Job Title
Starting Salary
$
Ending Salary
$
Ending Salary
$
Ending Salary
$
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
Company
Phone
Address
Supervisor
Job Title
Starting Salary
$
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
Company
Phone
Address
Supervisor
Job Title
Starting Salary
$
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
MILITARY SERVICE
Branch
From
To
Rank at Discharge
Type of Discharge
If other than honorable, explain
**************************************************************************************************************
**************************************************************************************************************
What Church are you a member? ___________________________________________________________________________
Address _______________________________________________________City____________________State_____Zip Code_________
Pastor’s Name ____________________________________________________Church Telephone No.____________________________
Why would you like to work at Circle Y Ranch? (please print) ______________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
What do you use for personal devotional time? __________________________________________________________
Please briefly state your relationship to Christ? (You may attach an additional sheet, if desired.)___________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
PLEASE RECORD THE NAMES OF THREE PERSONAL REFERENCES. DO NOT LIST FAMILY
MEMBERS OR RELATIVES.
Contact with references is required and is a condition of approval. The references must be over 18 years of age.
Please alert your references that someone from Circle Y Ranch will be contacting them regarding your application.
PREVIOUS CAMP EXPERIENCE OR TRAINING (SUMMARIZE YOUR CAMP EXPERIENCE BELOW.)
PERSON TO NOTIFY IN CASE OF EMERGENCY
Name
Street Address
City ST ZIP Code
Home Phone
Work Phone
E-Mail Address
AGREEMENT AND SIGNATURE
I affirm that the facts set forth are true and complete. I authorize any references or churches
listed in this application to give you any information that they may have regarding my character
and fitness for children or youth work. I authorize that a criminal records check be conducted on
me and that any information which pertains to any record of convictions contained in police files
or any criminal file maintained on me whether state or local be released to Circle Y Ranch. I
release any individual, church, youth organization, charity, employer, reference, Police
Departments, Circle Y Ranch or any other person or organization including record custodians,
both collectively and individually and those individuals receiving the results of the check from any
and all liability for damages of whatever kind or nature in regard to their release of information
or such disclosure. I also waive any right I may have to inspect any information provided about
me by those identified on this application. I understand that if I am hired as an employee of
Circle Y Ranch, any false statements, omissions, or other misrepresentations made by me on this
application may result in my immediate dismissal.
DISCLAIMER AND
SIGNATURE
I certify that my answers are true and complete to the best of my
knowledge. If this application leads to employment, I understand that
false or misleading information in my application or interview may
result in my release.
Signature
Print Name & Date
CIRCLE Y RANCH HIRING POLICY
It is the policy of this organization to provide equal opportunities without regard to race, color,
religion, national origin, gender, sexual preference, age, or disability. We are committed to
placing individuals who have no record of previous conviction for child sexual or physical abuse;
for whom we receive positive responses from their personal and professional references, in
addition to the Circle Y Ranch official background check; and who meet the qualifications of the
position for which they are applying. Should information be received that is questionable, the
individual will be asked to meet with the Camp Director and/or Camp CEO to clarify the
questionable issues prior to being placed in a position that relates to working with campers.
Thank you for completing this application form and for your interest in working at Circle Y Ranch.
EMAIL YOUR COMPLETED APPLICATION TO: SARRINGTON@CIRCLEYRANCH.ORG