Name *

Email *

Phone number *

Home Address *

Which position(s) are you interested in? *

Highest Level of Education Completed *

Are you currently Employed? *

Are you currently on lay off or subject to recall *

If yes to either of the above; Employer Name & Phone number

What experiences do you have working with children? *

Are you prevented lawfully from becoming employed in this county for any reason? *

Date you are available to start *

Hours of availability (Weekdays, list hours and days available) *

Previous work experience (Provide Employer Name, last position held and dates of employment) *

Please list three personal or professional references, not related to you (Provide Name, phone number, and relation to you) *

I understand that any false answer, statement or implication made by me on this form or on other required documents shall be considered sufficient cause for denial or termination of employment. I also understand that if hired, my employment will be contingent on the results of a background check; and that physical, psychological, and or drug testing may be required. This certifies that this form was completed by me and that all information provided herein is true and current to the best of my knowledge. *