Uriah Childcare Staffing Application

Name*

First NameLast Name

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth*

MonthDayYear

Social Security *

E-mail*

example@example.com

Cell Phone Number*

Area CodePhone Number

Are you a U.S. citizen or have appropriatedocumentation to show you are eligible to work in the U.S.? (Proof of citizenship or immigration status willbe required upon employment)*

YesNo

High School/Date of Completion

Education will be verified

Job Type

On what date would you be available to start? *

MonthDayYear

Does your health limit your ability to lift children, sit down on the floor, bend over to pick things up off the floor, use a vacuum or broom, or climb on a small step stool? *

YesNo

Are there any other reasons you would not be able to perform the duties associated with the position for which you are applying? *

YesNo

How did you hear about this position? *

What is your highest completed education?*

Are you CPR certified? *

YesNo

Please list any additional education/specialized training or certifications you have received.

Please list all current and previous experiences working with children & youth.*

What are your strengths in working with children?

Are you willing and able to work with any age child? (0-12 years) *

YesNoOther

CONFIDENTIAL Please answer the following questions honestly. Your answers to these questions will not necessarily disqualify you from a position.

Have you ever been convicted of a criminal offense (felony or misdemeanor)? Answer “yes” if you have entered a plea agreement including a deferred sentence or deferred judgment arrangement in connection with a criminal case.*

YesNo

Have you ever been charged or convicted of a crime of offense relating to children?*

YesNo

Have you ever been reported to any organization or registry for abuse or misconduct?*

YesNo

List job experience, starting with your present or most recent job.

Current or most recent Employer Name

Date range employed

CityState

Reason for Leaving?

Current Employer Phone Number

Area CodePhone Number

Past Employer

Past Employer Name

Date range employed

CityState

Reason for Leaving?

Past Employer Phone Number

Area CodePhone Number

Past Employer

Past Employer Name

Date range employed

CityState

Reason for Leaving?

Past Employer Phone Number

Area CodePhone Number

References

Personal Reference Name

First NameLast Name

Personal Reference E-mail

example@example.com

Personal Reference Phone Number

Area CodePhone Number

How do you know this person and for how long?

Professional Reference Name

First NameLast Name

Professional Reference E-mail

example@example.com

Professional Reference Phone Number

Area CodePhone Number

How do you know this person and for how long?

Please upload a current photo of yourself (Driver License, State ID, School ID)

Upload a File

Please! take a photo and email to:uriahchildcarestaffing@gmail.com

If you have a resume you would like to add you may upload it here.

Upload a File

Uriah Childcare Staffing is an employer that focus on the need of childcare facilities. Uriah Childcare Staffing exist because of a necessity to provide childcare facilities and schools with qualified child development teachers (Subs) anytime there is a staffing emergency

Uriah Childcare Staffing is an “AT-WILL” employer. The “AT-WILL” employment relationship affords the employee the right to resign for any reason. Likewise, the employer may terminate the relationship at any time, with or without cause and with or without notice. The “AT-WILL” employment relationship may not be altered by any written document or by verbal agreement, unless such alteration is specifically acknowledged in writing and signed by an authorized executive of Uriah Childcare Staffing. Once terminated,you will receive a separation notice from Uriah Childcare Staffing. By signing and submitting the form below, I indicate that I have carefully read the foregoing release, know and understand the contents. I also acknowledge that all of the information I have provided in this application is true and complete.

Please Sign*

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Consent

Yes, I agree to receive text messages from L.Askew Enterprise LLC DBA Uriah Childcare Staffing sent from 615-241-3038No, I do not want to receive text messages from L.Askew Enterprise LLC DBA Uriah Childcare Staffing.

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