Employment Application

EMPLOYMENT APPLICATION

RESUME

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GENERAL INFORMATION

Full Name*

First NameMiddle NameLast Name

List other names you have been known

Date of Birth*

Date

Social Security Number*

Are you authorize to work lawfully in the United States?*

YesNo

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

YesNo

Gender Assigned at Birth*

MaleFemale

Marital Status

SingleMarriedDivorcedWidow

CONTACT INFORMATION

Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Local Address (if BSU student)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mobile Phone Number*

Area CodePhone Number

E-mail*

EMERGENCY CONTACT INFO

Emergency Contact Name*

First NameLast Name

Relationship*

Emergency Contact Phone Number*

Area CodePhone Number

TRANSPORTATION

Do you have a Driver's License?*

YesNo

Can you provide proof of auto insurance?*

YesNo

AVAILABILITY

Date Available*

MonthDayYear

Employment Type Desired*

Full TimePart Time

Requested Number of hours per week*

Monday

Tuesday

Wednesday

Thursday

Friday

Are you willing to work when Ball State classes are not in session? Check all that apply*

Please list your class schedule for the current semester or email a copy of it to janelle@kaleidoscopekidsmuncie.com. If not a student, comment N/A*

Do you have any disabilities or other circumstances which may interfere with your ability to provide care to children at our childcare center?*

YesNo

If yes, please explain

If you are hired, do you consent to the following: 1) Kaleidoscope Kids may use my photograph , video or other digital media ("Photos") at any time for Kaleidoscope Kids publications including web based or paper, 2) Kaleidoscope Kids may copy, edit, enhance, crop or otherwise alter any Photos for their publications. I waive any rights for approval or inspection of any Photos, 3) I acknowledge that I am not entitled to any compensation or royalties with respect to the use of the Photos.*

YesNo

I understand a TB test is a requirement for employment. I understand I must get a TB test or provide documentation of receiving one in the prior 12 months. If I get a TB test through Kaleidoscope Kids I understand I will be responsible for the cost.*

YesNo

I understand a background check is required for employment. I understand I will be responsible for the cost of the fees through the Indiana State Police for the fingerprinting process*

YesNo

I understand a CPR certification is a requirement for employment. I understand that if I already have a valid/unexpired CPR certification I must provide documentation prior to my first day of employment. If I do not, I understand I will be required to complete this training.*

YesNo

I understand pre-employment and annual trainings are required for employment at Kaleidoscope Kids. I understand I will be paid for these trainings but not until all required trainings are completed along with any other requirements for the position I am offered.*

YesNo

EDUCATION

Highest level of education completed*

If you are a student, what is your major? If not a student, comment N/A*

SPECIALIZED EXPERIENCE, VOLUNTEER WORK, TRAINING, SKILLS*

Tell us about your character and work ethic. Tell us why you feel Kaleidoscope Kids will be a better place with you working here.*