WPCC Application for Employment

  • WPCC Application for Employment

  • Date of Application
     - -
  •  -
  • Date of Birth*
     - -
  • Have you ever been convicted of breaking a law other than a minor traffic violation?  If YES, give the date and explain fully below.*
  • Have you ever had an abuse or neglect or child maltreatment substantiation?*

  • Education

  • High School

  • Name of High School you attended/graduated from:      
    High School Location:      
    Dates you attended this school:       to           

  • Did you receive your High School Diploma?

  • Undergraduate Degree

  • College/University Attended:      
    College/University Location:      
    Dates you attended this school:  to    
    Course of Study:             

  • Did you graduate from this College/University?

  • Name of College/University Attended:      
    College/University Location:      
    Dates you attended this school:       to    
    Course of Study:             

  • Did you graduate from this College/University?

  • Graduate Degree

  • Name of College/University Attended:      
    College/University Location:      
    Dates you attended this school:       to    
    Course of Study:             

  • Did you graduate from this College/University?

  • Education, Vocational Schools, etc.

  • Name of School Attended:      
    School Location:      
    Dates you attended this school:       to    
    Course of Study:             
     

  • Did you graduate from this School?

  • References & Work History

  • Work History #1

    If you have not had work history please include internships or volunteer experience you have had related to early childhood.

  • Are you still employed with this company?*
  • Date Employed*
     - -
  • Date Separated
     - -
  • May we contact your employer?*
  • Did you work full-time or part-time?*

  • Work History #2

    If you have not had work history please include internships or volunteer experience you have had related to early childhood.

  • Date Employed
     - -
  • Date Separated
     - -
  • May we contact your employer?
  • Did you work full-time or part-time?

  • I certify that I have given true, accurate, and complete information on this form to the best of my knowledge. In the event confirmation is needed in connection with my work, I authorize educational institutions, associations, registration, and licensing boards, and others to furnish whatever detail is available concerning my qualifications. I authorize investigations of all statements made in this application and understand that false information of documentation, or a failure to disclose relevant information may be grounds for rejection of my application, disciplinary action, or dismissal if I am employed, and (or) criminal action. I further understand that dismissal on unemployment shall be mandatory if fraudulent disclosures are given to meet position qualifications.

  • Date*
     - -
  •  
  • Should be Empty: