CCDC JOB APPLICATION

JOB APPLICATION
503 4th St NE, Belmond, Iowa 50421

Colts Corner Daycare Center is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

Please fill out all of the sections below:
Applicant Name
Address

Address

Street Address Line 2

City, State and Zip CodeState / Province

Postal / Zip Code
Telephone Number
Email Address
example@example.com
Date of Application

MonthDayYear
Date
Please indicate which position(s) you are applying for: Classroom Lead (Full Time) and/or Classroom Assistant (Full and Part Time)
Desired Employment Position:
How did you hear about this position?
What days are you available for work?
What hours are you available for work?
On what date can you start working if you are hired?

MonthDayYear
Date
Do you have reliable transportation to and from work?
Are you 18 years of age or older?
Are you a U.S. citizen or approved to work in the United States?

YesNo
Do you have any condition which would require job accommodations?

YesNo
If yes, please describe accommodations required below:
Have you ever been convicted of a criminal offense (felony or misdemeanor)?

YesNo
If yes, please state the nature of the crime(s). when and where convicted and disposition of the case:
Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.
Please list below the skills and qualifications you possess for the position for which you are applying
(Note: Colts Comer Daycare Center complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions
Education and Training
High School Name
High School Location (City/State)
Year Graduated (High School)
Degree Earned (High School)
College/University Name
College/University Location (City/State)
Year Graduated (College/University)
Degree Earned (College/University)
Vocational School/Specialty Training Name
Vocational School/Specialty Training Location (City/State)
Year Graduated (Vocational School/Specialty Training)
Degree Earned (Vocational School/Specialty Training)
Are you a member of the Armed Services?

YesNo
What branch of the military did you enlist?
What was your military rank when discharged?
How many years did you serve in the military?
Previous Employment
Employer Name (1)
Job Title (1)
Supervisor Name (1)
City, State, and Zip Code (1)
Employer Telephone (1)
Start of Employment (1)

MonthDayYear
Start Date
End of Employment (1)

MonthDayYear
Date
Reason for Leaving (1)
Employer Name (2)
Job Title (2)
Supervisor Name (2)
City, State, and Zip Code (2)
Employer Telephone (2)
Start of Employment (2)

MonthDayYear
Date
End of Employment (2)

MonthDayYear
Date
Reason for Leaving (2)
Employer Name (3)
Job Title (3)
Supervisor Name (3)
City, State, and Zip Code (3)
Employer Telephone (3)
Start of Employment (3)

MonthDayYear
Date
End of Employment (3)

MonthDayYear
Date
Reason for Leaving (3)
References

Please provide 3 references below. Contact information should include phone number and/or email.
Reference (1)
Contact Information (1)
Reference (2)
Contact Information (2)
Reference (3)
Contact Information (3)
Are you currently certified in CPR and First Aid?
If not, are you willing to obtain certification in CPR and First Aid if offered this position?
Are you currently certified as a Mandatory Reporter in the State of Iowa?
If not, are you willing to obtain certification as a Mandatory Reporter if offered this position?
The relationship between you and Colts Corner Daycare Center (CCDC) is referred to as "employment at will". This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice. by you or the CCDC. No representative of CCDC has authority to enter into any agreement contrary to the foregoing "employment at will' relationship. You understand that your employment is "at will", and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status.
Applicant Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

JOB APPLICATION

Education and Training

Previous Employment

References