TLC Employment Application

Employment Application
Position you are applying for
Date Available to Start:

MonthDayYear
Date
Full Time or Part Time?
Desired Salary
Personal Information
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (Home / Cell)
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (Message)
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
Date
Social Security #

Education and Training
High School Name
Year Graduated
High School Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
College Name
Year Graduated
College Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
College Degrees Earned
Please list any additional training or certification that would be helpful when evaluating your application (45 HourEntry Level Course, CDA, First Aide, CPR, CDL License, etc):

Disclosures
We are committed to providing an equal opportunity work environment where everyone is treated with fairness, dignity, and respect. We will comply with all laws, regulations, and policies related to nondiscrimination in all of our personnel actions, including hiring, transfers, terminations, evaluations, recruiting, compensation, discipline, and promotion.
Before driving a vehicle to transport children, I understand that I am required to disclose any moving traffic violation that occurred five years prior to, during employment, or assignment as a driver. I further understand that I will be required to provide a copy of my driving record annually or more often at the request of the employer.
Applicant's Signature
Date

MonthDayYear
Date
I understand that upon employment, I will be required to submit written information to demonstrate that I possess the education, training, staff development, certification, and experience required for the job in which I have applied.

I hereby certify that the information given on this application is true and complete to the best of my knowledge.
Applicant's Signature
Date

MonthDayYear
Date
Internal Use Only
Hire Date:
Hired By:
Position:
Hourly Wage:
Start Date:
References documented by:
Should be Empty:

Employment Application