PCCC Employment Application

Applicant Information:

Full Name:*

First NameLast Name

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:*

Area CodePhone Number

Email:*

example@example.com

Position(s) of interest/application:*

Are you a US citizen or lawful permanent resident?*

YesNo

Are you at least 16 years of age?*

YesNo

Have you obtained a high school diploma or GED?*

YesNo

Have you ever been convicted of a felony or misdemeanor?*

YesNo

If you are offered employment at PCCC, how soon would you be able to start?*

Date

Qualifications:

Starting with the most recent, please list the schools you have attended, including your years of attendance and the qualifications that you received.

School Name 1:*

Years Attended:*

Qualification Received:*

School Name 2:

Years Attended:

Qualification Received:

School Name 3:

Years Attended:

Qualification Received:

Job Skills:

How would you rate your skills and abilities on the following criteria?

Communication:*

Customer Service:*

Organization:*

Adaptability:*

Decision Making:*

Reliability:*

Patience:*

Interpersonal Skills:*

Employment History:

Starting with the most recent, please list the your past employers

Employer 1 Name:*

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Contact Name:*

First NameLast Name

Contact Phone Number:*

Area CodePhone Number

Dates of Employment, From:*

Date

To:

Date

Dates of Employment:

I am still working here

Reason for Leaving:*

Employer 2 Name:

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Contact Name:

First NameLast Name

Contact Phone Number:

Area CodePhone Number

Dates of Employment, From:

Date

To:

Date

Dates of Employment:

I am still working here

Reason for Leaving:

Employer 2 Name:

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Contact Name:

First NameLast Name

Contact Phone Number:

Area CodePhone Number

Dates of Employment, From:

Date

To:

Date

Dates of Employment:

Type option 1

Reason for Leaving:

References:

Reference 1:*

First NameLast Name

Phone Number:*

Area CodePhone Number

Relationship to Applicant:*

Reference 2:*

First NameLast Name

Phone Number:*

Area CodePhone Number

Relationship to Applicant:*

Reference 3:*

First NameLast Name

Phone Number:*

Area CodePhone Number

Relationship to Applicant:*

Wrap-up:

Tell us why you would be a good fit for the position you are applying for, and a great addition to the PCCC team:

It is the policy of Phillipsburg Child Care Center to provide equal employment opportunities to all applicants and employees without regards to legally protected status such as race, color, religion, gender, national origin, age, disability, or veteran status.
I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.
I authorize Phillipsburg Child Care Center to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment and attendance. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

I HAVE FULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS

Signature*

Date*

Date

Please Click the "Submit" button below to complete your application.

PCCC Application for Employment