Online Employment Application

Name*
First Middle Last
Social Security #
Occupation
Spouse
First Middle Last
Social Security #
Occupation
Current Physical Address
Street Address Address Line 2 City State ZIP Code
Current Postal Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Work Phone
Spouse Work Phone
Names and Birthdates of Children
Position Qualified For and Desired*
Choose one (or both by holding shift key when clicking)
Have you or your spouse ever worked at a children’s home or facility?*
- Yes
- No
Name and location of Children’s Home or facility?
Experience in group care of children?
List all persons living at home
Name of Minister of Church now attending
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Do you have any serious physical problems? If so, please explain
Does your spouse have any serious physical problems? If so, please explain
Do you use tobacco in any form?
- Yes
- No
Do you drink alcoholic beverages?
- Yes
- No
Do you curse or use abusive language?
- Yes
- No
Have you ever been convicted of a felony?*
- Yes
- No
Have you ever been convicted on a moral charge?*
- Yes
- No
Have you ever been convicted on a physical violence charge?*
- Yes
- No
Have you ever been convicted on a child abuse or neglect charge?*
- Yes
- No
Are you a member of the Church of Christ?
- Yes
- No
Have you ever been married to anyone other than your present spouse?
- Yes
- No
Does your spouse use tobacco in any form?
- Yes
- No
Does your spouse drink alcoholic beverages?
- Yes
- No
Does your spouse curse or use abusive language?
- Yes
- No
Has your spouse ever been convicted of a felony?*
- Yes
- No
Has your spouse ever been convicted on a moral charge?*
- Yes
- No
Has your spouse ever been convicted on a physical violence charge?*
- Yes
- No
Has your spouse ever been convicted on a child abuse or neglect charge?*
- Yes
- No
Is your spouse a member of the Church of Christ?
- Yes
- No
Has your spouse ever been married to anyone other than you?
- Yes
- No
Your Education
Highest year completed of High School
Please enter a number from 9 to 12.
Grade 9-12
High School
Name
Date Graduated
MM slash DD slash YYYY
GED (if applicable)

Test Location / Date Received
CDA (if applicable)

Date Received
Highest year completed of College
- One
- Two
- Three
- Four
- Five
- Six
College
Name
Location
City State
Date Graduated
MM slash DD slash YYYY
Degree / Major / Minor
Your Spouse's Education
Highest year completed of High School
Please enter a number from 9 to 12.
Grade # 9-12
High School
Name
Location
City State
Date Graduated
MM slash DD slash YYYY
GED (if applicable)

Test Location / Date Received
CDA (if applicable)

Date Received
Highest year completed of College
- One
- Two
- Three
- Four
- Five
- Six
College
Name
Location
City State
Date Graduated
MM slash DD slash YYYY
Degree / Major / Minor
Previous Employment
List most recent first
Business Name (1)
Name
Date Started
MM slash DD slash YYYY
Date Ended
MM slash DD slash YYYY
Business Address
Street Address Address Line 2 City State ZIP Code
Business Phone #
Business Name (2)
Name
Date Started
MM slash DD slash YYYY
Date Ended
MM slash DD slash YYYY
Business Address
Street Address Address Line 2 City State ZIP Code
Business Phone #
Business Name (3)
Name
Date Started
MM slash DD slash YYYY
Date Ended
MM slash DD slash YYYY
Business Address
Street Address Address Line 2 City State ZIP Code
Business Phone #
Business Name (4)
Name
Date Started
MM slash DD slash YYYY
Date Ended
MM slash DD slash YYYY
Business Address
Street Address Address Line 2 City State ZIP Code
Business Phone #
Business Name (5)
Name
Date Started
MM slash DD slash YYYY
Date Ended
MM slash DD slash YYYY
Business Address
Street Address Address Line 2 City State ZIP Code
Business Phone #
Spouse's Previous Employment
List most recent first
Business Name (1)
Name
Date Started
MM slash DD slash YYYY
Date Ended
MM slash DD slash YYYY
Business Address
Street Address Address Line 2 City State ZIP Code
Business Phone #
Business Name (2)
Name
Date Started
MM slash DD slash YYYY
Date Ended
MM slash DD slash YYYY
Business Address
Street Address Address Line 2 City State ZIP Code
Business Phone #
Business Name (3)
Name
Date Started
MM slash DD slash YYYY
Date Ended
MM slash DD slash YYYY
Business Address
Street Address Address Line 2 City State ZIP Code
Business Phone #
Business Name (4)
Name
Date Started
MM slash DD slash YYYY
Date Ended
MM slash DD slash YYYY
Business Address
Street Address Address Line 2 City State ZIP Code
Business Phone #
Business Name (5)
Name
Date Started
MM slash DD slash YYYY
Date Ended
MM slash DD slash YYYY
Business Address
Street Address Address Line 2 City State ZIP Code
Business Phone #
Personal References
(list three persons, not related to you, that are familiar with your child care practices)
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Spouse's Personal References
(list three persons, not related to you, that are familiar with your child care practices)
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Have you or your spouse ever been involved in a child welfare investigation in this or any other state?*
- Yes
- No
Have you or your spouse ever been convicted of or entered a plea of guilty ornolo contendere (no contest) to any criminal activity involving violence against a person; child abuse or neglect; possession, sale or distribution of illegal drugs; sexual misconduct; gross irresponsibility or disregard for the safety of others*
- Yes
- No
If yes, provide additional information.
Special Skills or Qualifications:
APPLICANT’S STATEMENT TO THE TIPTON HOME
I verify all answers and responses on this application are true and complete. I authorize The Tipton Children's Home to investigate any information on this application. I understand The Tipton Children's Home will check for any criminal history. I understand any false or misleading information given by me may result in my discharge from employment. I also understand that, if I am hired, I am required to abide by all rules and regulations of Tipton Children's Home, the State of Oklahoma and any other agency with jurisdiction over The Tipton Children's Home. I understand to be employed, I must provide proof of citizenship. I agree that any employment relationship with The Tipton Children's Home is an “at will” nature, which means I may resign at any time and The Tipton Children's Home may discharge me at any time with or without cause. It is likewise agreed this “at will” employment relationship may not be changed except by the Executive Director’s written authorization.
Signature of Applicant*
First Last
Date of Signature*
MM slash DD slash YYYY
Signature of Spouse*
First Last
Date of Signature*
MM slash DD slash YYYY
Criminal Background Check
My signature being affixed below gives The Tipton Home permission to do a criminal check through the Oklahoma Bureau of Investigation and any and all states where I may have resided or are presently residing.
Signature of Applicant*
First Last
Date of Signature*
MM slash DD slash YYYY
Date of Birth
MM slash DD slash YYYY
Sex
- Male
- Female
Race
Alias Names
(includes maiden name, all married names, and any other names used)
Signature of Spouse*
First Last
Date of Signature*
MM slash DD slash YYYY
Date of Birth
MM slash DD slash YYYY
Sex
- Male
- Female
Race
Alias Names
(includes maiden name, all married names, and any other names used)
When would you be available for employment?
MM slash DD slash YYYY

Licensed by the state of Oklahoma Department of Human Services as a Residential Child Care Facility. We are a member of

Contact Information

1000 N Broadway
PO Box 370
Tipton OK 73570
(580) 667-5221
fax (580) 667-5224
Email Us

Tipton Children's Home

Online Employment Application

Your Education

Your Spouse's Education

Previous Employment

Spouse's Previous Employment

Personal References

Spouse's Personal References

APPLICANT’S STATEMENT TO THE TIPTON HOME

Criminal Background Check

Licensed by the state of Oklahoma Department of Human Services as a Residential Child Care Facility. We are a member of