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Application For Employment
Our policy is to provide equal opportunity to all qualified applicants and employees without regard to race, color, religion, national origin, ancestry, sex, age, disability, marital or veteran status or any other legally protected status or condition.
Email address *
Date *
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Name? Last, First and MI *
Your answer
Present Address? Street, City, State and Zip *
Your answer
Home phone #?
Your answer
Cell phone #? *
Your answer
Social Security #? *
Your answer
Position Applied For? *
Your answer
Salary requested? *
Your answer
Are you wanting to work full time or part time? *
If Part Time what days/hours are you available?
Your answer
Date available for employment? *
MM
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How were you referred to our company?
Your answer
Are you under 18 years of age? *
If yes, please state your age?
Your answer
Since reaching age 18, have you ever been convicted of any criminal offense other than a minor traffic violation? (Note: Convictions will not necessarily bar you from employment, but are viewed as related to the relevancy of the job applied for as well as the time of conviction.) *
If yes, when, where, disposition of the case?
Your answer
For reference checking purposes, please list other names under which you have worked or attended school? ie: Maiden name:
Your answer
Do you have relatives employed by this company? *
If yes, give the name and relationship please?
Your answer
Education: Name of High School attended? *
Your answer
Did you graduate? *
Name of College attended or attending? If not enrolled in college courses just put N/A please. *
Your answer
If attending or attended college please choose how far along you are with your degree/goal?
If you have graduated what is the degree you have earned?
Your answer
Other? Professional License/Certifications/Credentials? (Type, State, Expiration Date, Registration #)
Your answer
Please list all Employment History over the last 5 years starting with your most recent employer. Please answer in this order below and repeat with other work history............ Employer Name? Address? Dates Employed? Job Title? Ending Salary? Supervisor Name and phone #? Job Duties? Reason for Leaving? *
Your answer
If currently employed, may we contact your present employer for references?
Do you have a valid Driver's License in this state? *
If yes, what is your driver's license #?
Your answer
Please list any other jobs or volunteer work you have done related to childcare. Please include dates and the amount of time spent in these areas:
Your answer
Please list at least 3 references that you have known for at least 1 year. Prior supervisors in the child care field preferred but not required. 1) Please list Name? Title? Company? Telephone #? Years known? *
Your answer
Reference 2: *
Your answer
Reference 3: *
Your answer
Office use only: Director Notes
Your answer
I hereby affirm that information provided on this application is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions in my application or in the interview may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I authorize persons, schools, my current employer(if applicable), and previous employers and organizations named in this application to provide any relevant information that may be required to drive at at employment decision. In consideration of my employment, I agree to conform to the policies and rules of this Company and further agree and understand that my employment can be terminated, with or without cause, at any time at the discretion of the employer or myself. PLEASE TYPE FULL NAME AND DATE: *
Your answer
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