OKOLONA CHRISTIAN PRESCHOOL



Okolona Christian Preschool

Teacher’s Aide Application 2015

Name: ________________________________ Date: ___________________

Maiden Name: ___________________Phone Number:___________________

Address: _______________________________________________________

Email Address ___________________________________________________

When and how did you become a Christian? ___________________________

_______________________________________________________________

_______________________________________________________________

What church are you a member of? __________________________________

Date: __________________________________

When and where were you immersed? ________________________________

_______________________________________________________________

Types of ministries you’re involved in: ________________________________

_______________________________________________________________

_______________________________________________________________

Have you completed OCC’s Teacher Certification process? ________________

If yes, when:_____________________________________________________

Check the OCC Classes you have attended:

__________Pre-Membership ______________Basic Christianity

Do you have any doctrinal differences with the teaching of Okolona Christian Church?

Yes __________ No _________ If ‘Yes’, please explain:

_______________________________________________________________

_______________________________________________________________

Have you ever been convicted of a felony, or been involved with a child abuse or neglect court action or official investigation? YES _________ NO ________

Are you an adult survivor of child abuse? YES ___________ NO ___________

If yes to either of the above 2 questions, please explain:

______________________________________________________________________________________________________________________________

EDUCATION

High School:____________________ Date graduated:__________

City/State:____________________________________________

College: ______________________ Date graduated: ___________

City/State:____________________________________________

Degree Attained: _______________________________________

WORK EXPERIENCE

Name of Business and Supervisor

1. ___________________________________________________

Phone: _____________________ Dates:____________________

2. ___________________________________________________

Phone: _____________________ Dates:____________________

3. ___________________________________________________

Phone: _____________________ Dates:____________________

EXPERIENCE WITH PRESCHOOL CHILDREN

(other than above)

1. _____________________________________________

2. _____________________________________________

3. _____________________________________________

GIVE THE NAMES

AND PHONE NUMBER OF THREE REFERENCES

WHO ARE NOT RELATED TO YOU AND

WHO ARE NOT PREVIOUS EMPLOYERS:

1. _____________________________________________

2. _____________________________________________

3. _____________________________________________

As an applicant for the position of OCC Preschool Teacher, I hereby certify and attest as follows:

1. The information contained in this Application and any attachments is true to the best of my knowledge and belief. I understand that any misrepresentation, falsification, or material omission of information may result in my failure to receive an offer of employment, or, if I am hired, in my dismissal from employment.

2. I understand that selection for this position is not determined solely on the basis of performance and/or credentials, but that the applicant’s spiritual walk, commitment to the body of believers, spiritual gifts, and ministry abilities and passions will also have a significant impact on the decision process.

3. I understand that preference may be given to persons who are members of OCC.

4. I authorize the employers, schools, colleges, universities, references, churches, and/or any other persons listed in this application to provide any and all information that they may have concerning my prior employment, training and education, church involvement, and other factors that may have a bearing on my suitability for this position. I also release all parties from all liability for any damage that may result from the release of such information and/or its use by Okolona Christian Church. In conjunction with this release, I understand that I may be required to sign an additional Pre-Employment Inquiry Release.

5. I understand that, prior to hire, I will be required to sign a Statement of Faith, a copy of which has been made available to me.

Signature of Applicant: ______________________________ Date: ________________

EMPLOYMENT AUTHORIZATION FORM

During the application process and at any time during the tenure of my employment with Okolona Christian Church, I hereby authorize Okolona Christian Church and its designated agents and representatives to conduct a comprehensive review of my background through a consumer report (known as an investigative consumer report in California) which I understand may include verification of my social Security number; current and previous residences; employment history; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; other public records; and information regarding my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. This report may be compiled with information from credit bureaus, courts record repositories, departments of motor vehicles, past or present employers and educational institutions, governmental occupational licensing or registration entities, business or personal references, and any other source required to verify information that I have voluntarily supplied. I understand that I may request a complete and accurate disclosure of the nature and scope of the background verification, to the extent such investigation includes information bearing on my character, general reputation, personal characteristics or mode of living

_________________________________ _______________________

Applicant/Employee Name (please print) Date

_________________________________

Applicant/Employee Signature

________-_____-__________ ________________________

Social Security Number * Date of Birth *

* Optional

MN & Oklahoma Residents please note: In connection with your application for employment, your consumer report may be obtained and reviewed. Under Minnesota and Oklahoma law, you have a right to receive a free copy of your consumer report by checking the appropriate box below.

___ YES, I am a Minnesota resident and would like a free copy of my consumer report.

___ YES, I am an Oklahoma resident and would like a free copy of my consumer report.

CA Residents please note: In connection with your application for employment, your credit report will be obtained and reviewed. Under CA law, you have a right to receive a free copy of your credit report by checking the appropriate box below. Your credit report will be mailed to you by the credit bureau. In the alternative, you may elect to receive the entire investigative consumer report, which will include your credit report.

___ YES, I am a California resident and would like a free copy of my credit report; or

___ YES, I am a California resident and would like a free copy of my investigative consumer report.

Printed Name ________________________________

Street Address________________________________

City, State, Zip _______________________________

FOR OFFICE USE ONLY

Employer please note: If consumer checks “YES” regarding the credit report, and you do request a credit report, please fax this form to your First Advantage service center. If consumer checks “YES” regarding the full consumer report, and consumer resides in California, you will need to provide the individual with a copy of their consumer report.

Account Number: _________________ Revised 01/01/03

BACKGROUND VERIFICATION DISCLOSURE

As part of the employment process, Okolona Christian Church will obtain an investigative consumer report. The investigative consumer report may include information regarding your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living. The following Consumer Reporting Agency will prepare the report:

First Advantage Background Services Corp.

Consumer Center

P.O. Box 105292

Atlanta, GA 30348

California Notice:

You have the right under Section 1786.22 of the California Civil Code to contact First Advantage during normal business hours to obtain your file for your review. You may obtain such information as follows:

1. In person at First Advantage’s office at the address listed above. You will need to furnish proper

identification prior to receiving your file. You may have someone accompany you and should inform such person that they will also have to present reasonable identification. If you want First Advantage to disclose to or discuss your information with this third party, you may be required to provide a written statement granting First Advantage permission to do so.

2. By certified mail, if you make a written request (and provide proper identification) to have your file sent to a specified addressee.

3. By telephone, if you have previously made a written request and provided proper identification.

First Advantage has trained personnel to explain any information that is furnished to you and to explain any information that is coded.

-----------------------

For office use only:

Position: __________________________________________________

Employment Status: _________________________________________

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