APPLICATION FOR EMPLOYMENT

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 NameMiddle InitialLast Name
Today's Date

MonthDayYear
Date
Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
City, State

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
Format: (000) 000-0000.
E-Mail
example@example.com
Have you applied here before?
Position Desired
Have you worked here before?
Pay Expected
What date are you able to begin?

MonthDayYear
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:
Are you legally eligible for employment in the United States?
Are you 18 or older?
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.

Company Name
Telephone
City and State
Dates Employed
From:
To:
Name of Supervisor
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

MonthDayYear
Date
"Partnering with families to nurture and educate tomorrow's leaders"
Nordic (319) 266-4477 - Valley Park (319) 277-7303-Westridge (319) 234-5920
Should be Empty: