Homeparent Application

Shiloh Christian Children’s Ranch
601 North Center Street
Shelbina, Mo 63468
573-588-2191
www.shilohranch.org

Shiloh Christian Children’s Ranch is an Equal Opportunity Employer and does not discriminate in its hiring practices with regard to Race, Disability, Color, National Origin, Sex or Age.

Name of Couple
Address		City/State/Zip
Home Phone		Work Phone
Cell Phone		E-mail
County

Husband’s Information

Name:
Social Security #
Birth date
Driver’s License #		State

Education

High School Name/Location

Year Graduated

College, University, Technical/Business, Job related Training

Name of School	Location	Dates Attended		Rank in Grad Class	GPA	Major/Minor Course of Study	Type of Degree Earned
Name of School	Location	From	To	Rank in Grad Class	GPA	Major/Minor Course of Study	Type of Degree Earned

Employment

List your last 4 previous employers

Employer	Job Title	Address	Dates Employed
Employer	Job Title	Address	From	To

Wife’s Information

Name:
Social Security #
Birth date
Driver’s License #		State
Maiden Name:

Education

High School Name/Location

Year Graduated

College, University, Technical/Business, Job related Training

Name of School	Location	Dates Attended		Rank in Grad Class	GPA	Major/Minor Course of Study	Type of Degree Earned
Name of School	Location	From	To	Rank in Grad Class	GPA	Major/Minor Course of Study	Type of Degree Earned

Employment

List your last 4 previous employers

Employer	Job Title	Address	Dates Employed
Employer	Job Title	Address	From	To

Church Affiliation Information

List your denominational affiliation

List the name, address and phone number of congregation you are a member of:

Name

Address

Phone

List your Minister’s name, address, and phone number:

Name

Address

Phone

List three of your Elders’ names, addresses, and phone numbers that serve your congregation:

1.	Name	Address	Phone
2.	Name	Address	Phone
3.	Name	Address	Phone

Do you attend services of your congregation regularly? Explain.

Write in your own words what you believe about the church in the following areas:

How do we become part of the church?

How do we accept Jesus as the Son of God?

Share any other thoughts about your faith and beliefs….

List positions of responsibility that you have held or hold in your church life that have been helpful in preparing for a child care position.

Personal Information

List names, ages, and genders of your children:

	Name	Age	Gender
1.
2.
3.
4.

Do all your children live with you?

Have you ever been foster or adoptive parents? How many children have been involved in this care?

Do any of your children have special behavioral, medical, or physical needs? If yes, explain.

What qualifications do you possess that makes you a candidate for being a Shiloh homeparent?

Husband:

Wife:

Hobbies:

Husband:

Wife:

Answer the following questions as a couple:

Do you have any interest or experience in livestock, carpentry, mechanics, or butchering?

Can you relate to people in a positive manner?

Can you be submissive to those in authority over you? Explain.

Can you prepare meals for a large family?

Have you ever committed a felony?

Have either of you had previous marriages? If yes, how many? Husband Wife

Give circumstances:

Do you use any of the following: tobacco, alcohol, controlled substances, profane language? Please explain.

Name the last two movies you went to see at the theatre.

1. 2.

List the last two CD’s and DVD’s you purchased.

1. 2.

Name the two most recent books you have read.

1. 2.

Estimate the amount of time you spend per week on the following activities:

Video/computer games Television Internet

Employment Availability

Would you be willing to fill in for one of our homeparent couples for a three to seven day period to experience the position’s responsibilities and expectations?

Would you be available during the week or a weekend?

When would you be available to come as Shiloh Full-time Homeparents?

Would you allow Shiloh to request a background check?

Do you understand that either you or Shiloh can terminate employment at any time?

If we currently have no openings, may we keep your application on file for one year?
(After such time, you will need to reapply.)

Please note: Make sure that you have your financial obligations in order before you accept a position at Shiloh as the position of Homeparent is demanding. To carry out the responsibilities the position requires, financial burdens would be a hindrance to your ministry.

By checking the signature box below, we acknowledge that all answers and information in this application is correct:
Husband: Date: Wife: Date:

Please feel free to mail us an extra sheet or resume if you need space for additional information.