Career Application

Completing the form: Answer a few questions below and start the process of applying to become a childcare worker at one of our educational villages. You may want to follow up with a phone call to be sure we got your information.

First Name:
Middle Name:
Last Name:
Maiden Name and/or Other Legal Names by which You Have Been Known
First Name:
Middle Name:
Last Name:
Date of Birth:
Phone Number(s)
Phone Number:
Phone Number:
Current Address:
Address Line 2:
ZIP Code:

Part I: Referral Source

If you were referred to EH by someone in an organization, please provide the following information:
Name of Organization:
Name of Contact Person:
Phone Number:
If you were referred to EH by someone you know personally, please provide the following information:
Name of Person:
What is their relation to you?:
Phone Number:
If no agency or person referred you, how did you learn about Enhanced Horizons?:

Part II: Living Situation

Where do you currently reside?:
How long have you lived at your current residence?:
Where did you live before your current place of residence?:
Over the past year, where have you lived the longest?:

Part III: Education

Highest grade you have completed in school:
If you did not complete elementary or high school, please indicate why?:
Do you have a high school diploma?:
Did you complete the GED?:
Have you taken college courses?:
Are you currently attending school?:
If you are currently attending school, please complete the information below.
Name of School:
Hours Attended Per Week:
What is the name of the last school that you attended?
Name of School:
Did you attend full time or part time? :

Part IV: Work, Financial Status, and Transportation

Are you currently Employed?:
If Yes, please list the name of your current employer(s) and indicate the number of hours you work per week at each job:
Name of Employer:
Hours Worked Per Week:
If you are NOT working, please check the statement below that best describes your current situation:
What are your other sources of income or public assistance? (Check all that apply.)
Child Support:
Food Stamps:
Federal Financial Aid through a college or university:
Personal Savings or Checking Account:
Money from Friends and/or Family:
Other sources of income not listed above:
Are you currently in debt?:
If you chose Yes above, please explain what type of debt and the amount owed.:
Please indicate your current means of transportation. (Check all that apply.)
I own my own car/truck/motorcycle:
My friends/family take me places:
I ride with a coworker or fellow student to get to and from work and/or school:
Transportation is provided by either the place I live or the place I go to school:
Please list any other means of transportation that you use:

Part V: Social History

Have you ever been in trouble with the law?:
If Yes, please explain:
Have you ever been arrested?:
If Yes, please explain:
Have you ever had trouble with drugs or alcohol?:
If Yes, please explain:
Have you ever received counseling?:
If Yes, please explain:
If yes, was counseling helpful?:

Part VI: Medical/Mental Health History

Have you had any serious illnesses during the past five (5) years?:
If Yes, please describe:
What is the present state of your physical health?:
Please list any physical problems or conditions that you may have:
Please list any medications that you are currently taking and the reason for the medication (including birth control):

Part VII: Marital and Family

Are you:
Are you expecting a child?:
If Yes, when is the due date?:
Doctor's Name:
Do you have children?:
If Yes, how many children do you have?:
Please provide the following information about your children.
Date of Birth:
Girl / Boy:
Do you have custody?:
Do any of your children have medical problems?:
List any medications your children may be taking and the reason for the medication.
Child's Name:

Part VIII: Personal Statement

Please tell us why you would like to enter the Enhanced Horizons program. What are your personal goals and how can this program help you achieve your goals?:
Contact Patricia Neal, 149 Camp Scenic Road, Ingram, Texas 78025, phone (830) 367-4330 ext. 229.