530-584-2234 Tel Tahoedaycare.com
530-584-2236 Fax P.O.Box 1188
email@example.com Tahoe City, Ca
Application For Employment
SS # Phone #
-Can you provide proof, if hired, that you're eligible to work in the U.S.? Yes No
-Have you ever been convicted of a crime other than a minor traffic incident? Yes No
If Yes, please explain.
Have you had a background check? Yes No Have you had a TB Test? Yes No
Are you CPR/First Certified? Yes No If Yes, When was your last certification?
What days are you available?
When are you available to start?
Are you seeking short or long term employment?
Are you interested in “On Call” Substitute, Regular Set Schedule or Both?
Do you have a reliable car to get to work? Yes No Even in the winter months? Yes No
Wage expected? Do you smoke?
# of Years Completed
Did you Graduate?
Tell us about yourself?
What achievements are you most proud of?
What is your biggest strength?
What is your greatest weakness?
What are your 5 year plans?
Why are you a good candidate for this job?
Please list your present and past employment, starting with the most recent.
Be sure to have the best contact number listed below.
Reason For Leaving
I certify that the information given here is true and complete to the best of my knowledge. I understand that incorrect, misleading or incomplete information may result in immediate termination of employment.