Methodist Children’s Home

RECREATION INTERNSHIP APPLICATION

Karen Melton

1439 Ranch Rd

Waco, Tx 76706
kmelton@mchwaco.org

Methodist Children's Home is a quality professional ministry for children, youth, and families that manifest Christian compassion and healing. We expect all of our interns to conduct their professional and personal affairs in a manner that presents a positive role model for our children.

Mission Statement: Methodist Children's Home offers hope to children, youth and families through a nurturing, Christian community.

Name: Address: City-State-Zip: E-mail:	Desired Internship Semester Date: Telephone #1 Tel.#2 (Cell)
Have you worked for Methodist Children's Home before? Yes       No
Do you have a valid Drivers License? Yes       No    Driver's License No.____________ State:________ Is your Driver's License active? Yes       No Note: You must have an active Driver's License Do you have valid auto liability insurance coverage? Yes       No Have you had 3 or more traffic tickets or accidents in the last 3 years? Yes       No Have you been convicted of, or have you pleaded guilty or no contest to a felony or misdemeanor offense? Yes       No Do you have criminal charges pending against you at this time? Yes       No     Charges:____________________ If the answer to any questions is yes, please explain: Describe any skills, strengths or experiences which would help you fulfill this internship. _____________________ ____________________________________________________________________________________________ Methodist Children's Home does not discriminate based on sex, race, color, religion, national origin, age, veteran status or political beliefs. Physical or mental challenges will not disqualify an applicant who meets bona fide job requirements. The Home does not knowingly employ individuals or contribute funds to organizations found on terrorist lists promulgated by the U.S. Government, the U.N., or the European Union. EMPLOYMENT DATA Beginning with your current or most recent job, complete the following information for both full-time and part time jobs. Account for all time periods. Methodist Children's Home may contact these companies regarding employment unless noted below.
Company__________________________________ Address:__________________________________ City-State-Zip:______________________________ Your Position:______________________________ Name/Title of Supervisor:	Date Started:__________________________ Date Left:_____________________________ Telephone & extension:__________________ Last Pay Rate:_________________________ Dept. Worked:_________________________
Description of Job Duties: Reason for Leaving: Do not contact because:_____________________________________________________________________
Company__________________________________ Address:__________________________________ City-State-Zip:______________________________ Your Position:______________________________ Name/Title of Supervisor:	Date Started:__________________________ Date Left:_____________________________ Telephone & extension:__________________ Last Pay Rate:_________________________ Dept. Worked:_________________________
Description of Job Duties: Reason for Leaving: Do not contact because:_____________________________________________________________________
Company__________________________________ Address:__________________________________ City-State-Zip:______________________________ Your Position:______________________________ Name/Title of Supervisor:	Date Started:__________________________ Date Left:_____________________________ Telephone & extension:__________________ Last Pay Rate:_________________________ Dept. Worked:_________________________
Description of Job Duties: Reason for Leaving: Do not contact because:_____________________________________________________________________
Describe why you are applying for this internship. Describe work, volunteer or personal experiences in supervising groups of children. Why do you think you can effectively supervise groups of children? Why do you feel that group child/youth care work is the right internship for you? Do you prefer to work with a particular age group or sex? Why? Other comments relating to working with a group of children & youth on a daily basis.
EDUCATION DATA

Name and Location

Specialization

Years Attended

Degree/Diploma

High School

____________________________________________________________________________________________

College/University

____________________________________________________________________________________________

Other

____________________________________________________________________________________________

PERSONAL REFERENCES (Not Relatives; list your intern supervisor)
Name and Occupation	Email Address	Telephone Number
1.____________________________________________________________________________________________ 2.____________________________________________________________________________________________ 3.____________________________________________________________________________________________
IMPORTANT INFORMATION FOR ALL APPLICANTS Methodist Children’s Home is a faith-based, non-profit residential child care facility serving approximately 250 dependent, neglected and abused children from various locations throughout Texas and New Mexico. The Home is licensed and actively regulated by the Texas Department of Protective and Regulatory Services and is frequently and periodically audited and reviewed by licensing investigators for compliance with State Licensing Standards and the Texas Family Code. In a diligent effort to protect the children we serve from further forms of abuse, neglect or other victimization, the Home is required to thoroughly screen and hold all staff members to a very high degree of accountability and professional conduct. All applicants for employment will be screened by thorough: sex offender registry check, criminal history and central registry background checks; driving records checks; personal and employment reference checks; and drug testing. Additionally, the Home reserves the right to require any employee to submit to a drug or alcohol screen if there is cause or reason to believe that the employee is under the influence of either alcohol or illegal drugs. The Home will also cooperate fully with all law enforcement authorities in the prosecution of any individual found to be involving or exposing any child or young person in care, to any illicit activities and/or unlawful behavior(s). As an applicant and potential new employee for the Home, do you consent to a pre-employment drug/alcohol screen? Yes       No It is the practice of the Home to provide For Cause drug/alcohol screening. Do you consent to a drug/alcohol screen if employed and required to do so as a result of suspicious behavior(s) while on duty?  Yes       No Please note: References and/or data that cannot be verified could delay the applicant from further consideration for employment. I have read and understand the conditions for employment identified above. Name of Applicant Printed _______________________________________