Employment Application 2019

Roundup Fellowship Online Application
  • SCHOOLING, COLLEGE, GRADUATE TRAINING: We will need to see verification of your education in the form of transcripts, diploma, license or other credential.
  • HEALTH: Rules and regulations require that we check the physical and emotional health of prospective employees in order to properly protect the health and safety of those we serve.
  • REFERENCES: Professional references are required. Three references are necessary. At least 2 must be familiar with your work performance, with 1 being a supervisor. DO NOT indicate "please see resume". Incomplete or inaccurate information will delay the hiring process.
  • PERJURY AGREEMENT (Please read each statement carefully before signing.) "Any applicant who knowingly or willingly makes a false statement of any material fact or thing in the application is guilty of perjury in the second degree as defined in Section 18-8-503, CRS., and, upon conviction thereof, shall be punished accordingly." I certify that answers given herein 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 a decision for employment. In the event of employment, I understand that false or misleading information given in this application, or subsequent employment does not create a contract of employment and does not guarantee employment for any definite period of time. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time with or without cause and with or without notice. I have read, understand and by my signature consent to these statements.
  • ADDENDUM TO APPLICATION *CRIMINAL RECORD CHECK AND CHECK OF THE CONFIDENTIAL CHILD ABUSE/NEGLECT DATABASE* Under the rules of the Colorado Department of Human Services, all employees of child care facilities must submit fingerprints to the Colorado Bureau of Investigation(CBI)and the FBI before unsupervised contact/within 5 days of hire. Roundup must request that the employee provide more detailed information regarding any criminal record. Roundup will terminate the employment of any person who has been convicted or entered into deferred judgement agreement for the following types of crimes: 1) Any crime of insest, child abuse, child sexual abuse, kidnapping of a child, unlawful sexual behavior, crime committed against a vulnerable adult, or murder; 2) Any crime which involved child prostitution or the sale or possession of sexually explicit materials harmful to children; 3) Any felony for which an individual has not yet completed the sentence; 4) Any felony of a violent nature including but not limited to assault, kidnapping, or robbery; 5) Any felony related to the sale of a controlled substance within the past 10 years; 6) Any crime which adversely reflects upon the character and suitability of the employee, posing a threat to the health, welfare and safety of the adults or children we serve. The cost of the criminal record check is incurred by the employee and will be deducted from the employee's first paycheck, unless otherwise arranged with the executive director. The employee will be reimbursed for this expense upon completion of six months of employment. See the current cost of criminal record check at the bottom of this addendum. Roundup is also required to submit the Facility Request for Background Investigation in the Confidential Child Abuse/Neglect Database to assure there are no confirmed reports of abuse or neglect. Roundup must request an employee to provide more detailed information regarding any findings. Employees with confirmed reports of abuse or neglect may be terminated immediately. In acknowledgement of your understanding of the above. Please sign and date the following statement. I, the undersigned, understand that fingerprinting, a criminal records check, and a check of the Child Abuse/Neglect database are conditions of employment at Roundup Fellowship. I have not been convicted or entered into a deferred judgment agreement for any of the crimes listed above. I understand that if I am found to have a criminal record or a confirmed report of abuse or neglect, my employment may be terminated immediately. span>
  • CURRENT COSTS FOR CBI/FBI, EFFECTIVE 2/26/2015 CBI Name Check Only = $6.85 Fingerprints = $5 - $20 per card CBI & FBI check = $39.50
  • Roundup Fellowship Application Questionnaire 1. Please rank the following from most important to least important (#1 being the most and #5 being the least):
  • 2. You and Karen go to McDonald's for your weekly outing. This week Karen decides she wants a shake instead of a Diet Coke. Since she is on a diet, you tell her she can only have the Diet Coke. She starts screaming, hitting you and falls to the floor.
  • LIABILITY RELEASE TO WHOM IT MAY CONCERN: As an applicant for employment with Roundup Fellowship, I understand that a thorough background investigation will be conducted to qualify my for eligibility. “I hereby authorize the custodian of any information related to my previous employment, driving record, education, residence, criminal convictions, credit standing, or character, to release said information to the person or agency identified herein, unless restricted by law. This authorization is made voluntarily, for the purpose of employment only. Upon receipt of this document, please release information directly related to the categories shown, and to which you have direct knowledge or documented evidence. I agree to hold harmless any individual or agency involved with the authorized release of legitimate information. Thank you for your cooperation.


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