EMPLOYMENT APPLICATION

Rocketown is an equal opportunity employer. It is our policy that all applicants be considered equally on the basis of qualifications and ability, without regard to race, color, sex, national origin, or disability. Date of Application: ____/____/____ Position applying for: o Full Time Staff Title: ______________________ o Part Time Staff Title: ______________________ o Internship Dept./Major: ________________
Last Name Address Telephone Numbers Home Work First Name City State Email Address Middle Name Zip

Cell

EDUCATION
Name and Address of School High School Course of Study Dates Attended Diploma/Degree

Undergraduate/College

Graduate/Professional Other (Specify)

Rocketown Application for Employment

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EMPLOYMENT EXPERIENCE
Start with your present or last job. Include any job-related military service assignments and volunteer activities. If you need additional space, please continue on a separate sheet of paper. Employer Dates Employed From Address To Work Performed

Telephone Number Job Title Supervisor

Hourly Rate/Salary Starting Final

Reason for Leaving

Employer

Dates Employed From To

Work Performed

Address

Telephone Number Job Title Supervisor

Hourly Rate/Salary Starting Final

Reason for Leaving

Employer

Dates Employed From To

Work Performed

Address

Telephone Number Job Title Supervisor

Hourly Rate/Salary Starting Final

Reason for Leaving

Rocketown Application for Employment

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Professional References (please give name, company, and phone number): 1. _______________________________________________________________ 2. _______________________________________________________________ Computer Software Proficiencies: _________________________________________________________________ _________________________________________________________________ Language Proficiencies: _____________________________________________ Current Hobbies/Recreational Activities: _________________________________________________________________ _________________________________________________________________ Have you previously worked for Rocketown, Inc. or Rocketown Youth Services? YES NO If yes, when? ____________ In what capacity? __________________________ Do you have the legal right to work permanently in the U.S.? YES NO If no, explain: _____________________________________________________ If yes to any of the following four questions, please explain the circumstances, including dates, charges, resolution, etc in the space below. Use extra sheet if necessary. Have you ever been convicted of a crime? (Conviction will not necessarily disqualify an applicant.) YES NO Have you ever been investigated for, charged with, or convicted of any form of child abuse? YES NO Have you ever been investigated for, charged with, or convicted of possession of illegal drugs? YES NO Have you ever been investigated for, charged with, or convicted of any form of sexual misconduct? YES NO ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

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ADDITIONAL INFORMATION 1. Are you currently a member of a church? YES NO If yes, what church? _____________________________________________ 2. In what activities are you involved at your church?

3. What experience do you have working with Jr./Sr. High School Students?

4. Please describe your Christian journey, including your current relationship with Jesus Christ.

5. Who is the main person to impact your life for Christ? How has he/she impacted you?

6. What do you feel is the best way to guide someone into a personal relationship with Jesus Christ?

7. What creates the most anxiety or fear for you about working with teenagers?

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Please list one personal and one pastoral reference (the staff member at your church most acquainted with you and your walk with Christ) and let them know a Rocketown staff member will be calling them. Name Relationship Phone #(s) 1. ___________________________________________________________ 2. ___________________________________________________________ By signing this application, I certify that this application is complete and accurate to the best of my knowledge, that I have not made any attempt to conceal information, and that falsification could be cause for dismissal. Furthermore, Rocketown or its agents may request employment information from my previous employers and persons or corporations who provide information related to my previous employment and will be released from any liability or damage. I understand that employment will be subject to: Passing any and all background check mechanisms deemed necessary by Rocketown Staff; Receiving satisfactory reference reports; Receiving favorable reports from any outside agency on verification of information supplied.

Applicant Signature: ________________________________________________ Date: __________________________________

Rocketown Application for Employment

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