Community United Child Care Centers, Inc
Child Development Centers - Administration Office
1026 E Seerley Blvd, Cedar Falls, IA 50613
(319) 277-7303, (319) 277-0472 fax
www.cuccc.org
rev 03/11/26
APPLICATION FOR EMPLOYMENT
CUCCC does not discriminate based on race, creed, color, sex, age, disability, religion, national origin, gender identity, sexual orientation, or genetics.
Name
First Name
Middle Initial
Last Name
Today's Date
-
Month
-
Day
Year
Date
Street Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
City, State, Zip
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
Format: (000) 000-0000.
E-Mail
example@example.com
Have you applied here before?
Yes
No
When
Position Desired
Have you worked here before?
Yes
No
Date:
Location
Pay Expected
What date are you able to begin?
-
Month
-
Day
Year
Date
Full time or part time?
We are open from 6 am - 6 pm - what is your availability?
Monday
Tuesday
Wednesday
Thursday
Friday
How many hours a week are you looking for?
Location Preference:
Waterloo
Cedar Falls
Either
Are you legally eligible for employment in the United States?
Yes
No
Are you 18 or older?
Yes
No
Law requires us to perform background checks. Do you have a record of founded child or dependent adult abuse?
Yes
No
If "Yes" explain:
Describe any training received relevant to the position for which you are applying.
Rows
Name and Location of School
Course of Study
Did you graduate?
Type of Degree or Diploma
College or Higher Education
High School or GED
"Partnering with families to nurture and educate tomorrow's leaders"
Nordic (319) 266-4477 - Valley Park (319) 277-7303 - Westridge (319) 234-5920
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Community United Child Care Centers, Inc
Child Development Centers - Administration Office
1026 E Seerley Blvd, Cedar Falls, IA 50613
(319) 277-7303, (319) 277-0472 fax
www.cuccc.org
rev 03/11/26
Company Name
Telephone
City and State
Employed
Name of Supervisor
From:
To:
Job Title and Describe Your Work
Reason for Leaving
Company Name
Telephone
City and State
Employed
Name of Supervisor
From:
To:
Job Title and Describe Your Work
Reason for Leaving
Company Name
Telephone
City and State
Employed
Name of Supervisor
From:
To:
Job Title and Describe Your Work
Reason for Leaving
Will you require childcare for your own children? If so, please list name, age and date of birth:
Email application to adminped@cuccc.org or take to any center
I certify that, to the best of my knowledge and belief, all of the information on and attached to this application is
true, correct, complete, and made in good faith. I understand that false or fraudulent information on or attached to
this application may be grounds for not hiring me or for firing me after I begin work, I understand that any
information I give may be investigated.
I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer
to continue to employ me or for me to continue my employment with CUCCC in the future.
Signature
Date
-
Month
-
Day
Year
Date
"Partnering with families to nurture and educate tomorrow's leaders"
Nordic (319) 266-4477 - Valley Park (319) 277-7303-Westridge (319) 234-5920
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