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Brookhaven Youth Ranch Online Application:

 

First Name: Middle Name: Last Name:

List any other name(s) used (Maiden or Alias)

Street Address:

City: County: State: Zip:

Phone: Cell Phone:

Date of Birth: Social Security Number: Drivers License Number and State:

What is your E-Mail Address?:

Position(s) Applied For: Full Time (40 hrs/wk) Part Time (Less than 30 hrs /wk)

Are You Willing To Work Any Shift?      Yes  No       If No, Preferred Shift:

Are you a citizen of the United States? Yes No    If no are you authorized to work in the US? Yes No

Have you filed an application here before? Yes No If yes, when?

Have you ever been arrested: Yes  No  If yes, for what?

Have you ever been charged or convicted of a misdemeanor? Yes No  If yes, explain:

Have you ever been charged or convicted of a felony? Yes No  If yes, explain:

Have you ever been charged or convicted of any crimes against a child? Yes No  If yes, explain:

Are you currently charged with a felony or misdemeanor classified as an offense involving or against any of the following; a person, family, public indecency

or any violation of the Texas Controlled Substance Act? Yes  No     If yes, provide a detailed account of the circumstances surrounding the charges:

In accordance with the Department of Family and Protective Services Standards, we are required to conduct a criminal record check on perspective employees

at facilities where students are located prior to hiring to determine whether they have committed acts which might have a specific relationship to their job

performance.  To comply with this request, please furnish the following information:

Height: Weight: Hair Color: Eye Color:

State of Birth: Race:   White,  Black,   Hispanic,  Other: Gender: Male Female

List all other cities in Texas where you have lived:

Have you resided out of the state of Texas in the last 5 years?  Yes  No  If yes, please list all out of state addresses, including the COUNTY in which you lived:

Education:  It is required that you furnish a copy of you high school diploma or GED certificate within 3 days of submitting this application.

Your application will not be considered until this is submitted.

High School Attended: Address:

From (years) to Did you graduate?  Yes  No

College Attended : Address:

From (years) to Did you graduate?  Yes  No  Degree:

College Attended : Address:

From (years) to Did you graduate?  Yes  No  Degree:

Employment History:

Company: Phone: Address:

Supervisor: Job Title: Starting Salary: Ending Salary:

Responsibilities:

Date Hired: Date Ended Employment: Reason for leaving:

Company: Phone: Address:

Supervisor: Job Title: Starting Salary: Ending Salary:

Responsibilities:

Date Hired: Date Ended Employment: Reason for leaving:

Company: Phone: Address:

Supervisor: Job Title: Starting Salary: Ending Salary:

Responsibilities:

Date Hired: Date Ended Employment: Reason for leaving:

Company: Phone: Address:

Supervisor: Job Title: Starting Salary: Ending Salary:

Responsibilities:

Date Hired: Date Ended Employment: Reason for leaving:

Military Service:

Branch: Year enlisted: Year Discharged:   Rank at discharge: Type of discharge:

If less than honorable, explain:

 

Note:  You must have a current (within the last 2 years) TB Test to work at Brookhaven. If you do not have this, you must obtain within 15 days of being hired. 

 

All applicants, prior to beginning employment, are required by TDFPS to be fingerprinted. This cost $42.64 and is the responsibility of the prospective employee. You

have the option of paying for this immediately or having it deducted from your first paycheck.

 

All new hires will be drug tested. Testing will be conducted on ALL new hires within 15 days of their employment.  Any type of attempt to manipulate the drug test is considered

a “dirty” test and will result in the potential new hire not being hired.  Brookhaven will pay for the Rapid Screen Drug Test.  If you want a second drug test, you will be responsible

for payment of the second test.

 

Once you fill out your application, a criminal background history will be run through TDFPS.  A criminal background history can take anywhere from 2 days to several

weeks…..this is processed through the state and is out of Brookhaven's control. Once cleared, your application will be forwarded to our Treatment Director and Program Director. 

If they feel like you are a good candidate for the position, they will call you and schedule an interview.  If you are hired, please proceed immediately to the Administration

Office to complete your paperwork.

 

 

DISCLAIMER and SIGNATURE

I certify that my answers are true and complete to the best of my knowledge.

 

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. 

 

I understand that this application is not and is not intended to be a contract of employment.

 

I have read and understand the statement concerning fingerprinting and drug testing.

 

In the event of employment, I understand that false or misleading information given in my application or my interview may result in discharge. 

I understand that I am required to abide by all rules and regulations of Brookhaven Youth Ranch.  I also understand that I may have to work

different shifts.  I understand that if I am employed by Brookhaven Youth Ranch, I must maintain a clear criminal history check during my tenure

to remain employed at Brookhaven Youth Ranch.  Criminal History checks are conducted every two years.  If at any time I receive a bad Criminal

History check, my employment with Brookhaven may be terminated. 

 

 

BY CHECKING THE FOLLOWING BOX AND BY TYPING MY NAME IN THE SIGNATURE BOX BELOW I AM VERIFYING THAT

I AGREE WITH AND CONSENT TO THE ABOVE:       SIGNATURE BOX:

 

Note: In order to process your application we must have a CURRENT copy of your Driver’s License, Social Security Card and High School Diploma/GED. You may submit these in one of the

following ways: 

 

                        (1) Scan and e-mail copies to cindy.brookhaven@outlook.com

                        (2) Fax the copies to (254) 829-1469

                        (3) Bring them or mail them to: Brookhaven Youth Ranch, 5467 Rogers Hill Road, West, Texas   76691

If you have questions concerning this application please call Cindy Graham at: 254-829-1893

 

Authorization to verify drivers license:

In order to drive Brookhaven Youth Ranch vehicles, I understand that I must possess a current VALID Texas Driver’s License.  Brookhaven Youth Ranch will verify this information by visiting

TXDPS’s secure website, www.dps.texas.gov.  My Driver’s license, date of birth and last four digits of my social security number are required and will be entered.  I also understand that

Brookhaven will periodically verify this information during my employment for ranch vehicle insurance purposes.  In the event my license becomes invalid, I understand that I am subject to

suspension and/or termination.

DL# Date of Birth: Last four digits of Social Security #

 

BY CHECKING THE FOLLOWING BOX AND BY TYPING MY NAME IN THE SIGNATURE BOX BELOW I AM VERIFYING THAT

I AGREE WITH AND CONSENT TO THE ABOVE:       SIGNATURE BOX:

 

 


 

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Copyright © 2011 Brookhaven Youth Ranch,  last modified: 03/09/2012                                                                                                                                                  Hit Counter