Employment Application
Employment Application for Estill Child Development Center
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APPLICANT INFORMATION
Full Name *
Birthdate *
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YYYY
Social Security Number *
Date Available *
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YYYY
Address *
Phone *
Email *
Are you a citizen of the United States? *
Have you ever been convicted of a felony? *
EDUCATION
High School Name
Attended From _________ to _________
Did you receive a diploma?
 *
College Name
Attended From _________ to ________
Major/Minor
Did you receive a diploma?
Other Educational Institutions
Attended From __________ to __________
Certificates/diplomas received
REFERENCES
Professional Reference
Name
Relationship
Company
Phone
Email
 *
Professional Reference
Name
Relationship
Company
Phone
Email
 *
Character Reference
Name
Relationship
Company
Phone
Email
 *
PREVIOUS EMPLOYMENT
Employer
Supervisor
Employed From _____________ to ____________
Address
Phone
Email
May we contact this reference?
Job Title
Starting/Ending Pay
Responsibilities 
Reason for Leaving

 *
Employer
Supervisor
Employed From _____________ to ____________
Address
Phone
Email
May we contact this reference?
Job Title
Starting/Ending Pay
Responsibilities 
Reason for Leaving
Employer
Supervisor
Employed From _____________ to ____________
Address
Phone
Email
May we contact this reference?
Job Title
Starting/Ending Pay
Responsibilities 
Reason for Leaving
QUALIFICATIONS/SEEKED POSITION
Position Interested In *
Desired Pay
Preferred Age Group *
Interested in Working *
Days and Hours Available to Work *
Are you currently infant/child CPR Certified? *
Are you currently infant/child First Aid Certified? *
Do you have a Food Handlers Card? *
Do you have a current TB Skin Test? *
Have you worked in childcare before? If yes, please describe what ages you worked with and what you learned during that experience that you would apply directly to this position if hired.
Why are you interested in applying to work for Estill Child Development Center and what qualifications/skills do you plan to bring to this position if hired? *
If offered a position at ECDC, would you need childcare for your own children? If yes, what ages? *
Any Other Comments
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I also understand that if this application leads to employment, I will be asked to complete numerous background checks and provide documentation referring to my education, citizenship, and may be asked to provide Estill Child Development Center with a drug screen prior to being scheduled for a shift.

Please Electronically Sign Below.
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