Harvest Child Care Ministries is always seeking dedicated individuals to add to our staff.
For consideration, print and fill out the online application and mail it to:

HARVEST FREE WILL BAPTIST
CHILD CARE MINISTRIES
P.O. BOX 259, DUFFIELD, VA 24244

Application for Employment

Harvest is an equal opportunity employer, dedicated to non-discrimination on any basis including race, color, age, sex, religion, or national origin.

PERSONAL INFORMATION:

Full Name: ___________________________________________ SS#:_________________________

Address: _________________________________________________________________________

Phone: __________________________________ Message No.: ______________________________

Previous Names:___________________________________________________________________

EMPLOYMENT DESIRED:

Position: ___________________________________________ Date You Can Start: _______________

Minimum Salary Range You Will Accept: _________________________________________________

Are You Able to Work a "Live-In" Position, such as 5 days on/5 off? ______ Yes ______ No

EDUCATION:

  Name & Location Last Year Completed Graduate? Degree/Area
High School   1 2 3 4 Yes
No
 
College   1 2 3 4 Yes
No
 
Other   1 2 3 4 Yes
No
 

Do you hold any professional licenses or certifications? _________________________________________

________________________________________________________________________________

PHYSICAL RECORD:

Do You Have Any Physical Condition Which May Limit Your Ability to Perform the Job Applied for? ________

Explain: __________________________________________________________________________

In Case of Emergency Notify: Name: _____________________________________________________

Address: ____________________________________________ Phone: ________________________

FORMER EMPLOYERS: List Below Your Last 4 Employers in Reverse Order

Dates Name & Address Salary Position & Duties Reason for Leaving
 


 


$


 


 


 


 


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REFERENCES: List below 3 persons not related to you whom you have known at least one year and who are not former employers

Name Address Phone Years Known
 

 

 

 

 



 

 

 



 

 

Drivers'
License # _____________________________ State ______ Class/Endorsements __________________

Violations ________________________________________________________________________

Have you ever been convicted of any criminal act?_______

If yes, Please explain _________________________________________________________________

________________________________________________________________________________

Hobbies or Other Interests: ____________________________________________________________

________________________________________________________________________________

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice.

 

Signature: _______________________________________________ Date: ____________________


II-3-F
rev.07/12/94