CUCCC Application

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

"Partnering with families to nurture and educate tomorrow's leaders"

Nordic 319-266-4477 - Valley Park 319-277-7303 - Westridge 319-234-5920

Question email adminped@cuccc.org

CUCCC does not discriminate based on race. creed. color. sex. age. disability. religion. national origin. gender identity, sexual orientation. or genetics.

Date of application*

Last Name*

First*

Middle

Street Address*

City. State, Zip*

Telephone*

Email*

example@example.com

Last 4 digits of Social Security #*

Position Desired*

Are you 18 years old or older? Yes or No*

Have you applied here before? Yes or No*

If "Yes" Dates

Have you worked here before? Yes of No*

If "Yes" Dates

Pay Expected

What days and hours are you available you work?*

Will you work overtime if asked? Yes or No

What date are you able to begin?*

Are you legally eligible for employment in the United States? Yes or No*

Law requires us to perform background checks. Do you have a record of founded child or dependent adult abuse? If "Yes" explain*

Describe any training received relevant to the position for which you are applying.

College with type of degree / diploma

Trade or Technical with type of degree / diploma

High School or GED with type of degree / diploma*

Please give accurate and complete employment history. Start with you present or most recent employer.

Company Name #1*

Telephone

Address (with city and state)*

Employed from (month and year)*

Name of Supervisor*

Pay rate

Job Title and Describe Your Work*

Reason for Leaving*

Company Name #2*

Telephone

Address (with city and state)*

Employed from (month and year)*

Name of Supervisor*

Pay rate

Job Title and Describe Your Work*

Reason for Leaving*

Company Name #3*

Telephone

Address (with city and state)*

Employed from (month and year)*

Name of Supervisor*

Pay rate

Job Title and Describe Your Work*

Reason for Leaving*

Company Name #4

Telephone

Address (with city and state)

Employed from (month and year)

Name of Supervisor

Pay rate

Job Title and Describe Your Work

Reason for Leaving

Membership in Professional or Civic Organizations

Name #1*

Relationship*

Years Known*

Contact Information*

Name #2*

Relationship*

Years Known*

Contact Information*

Name #3*

Relationship*

Years Known*

Contact Information*

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*

REFERENCES