APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT
Name:*
Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
HOW WERE YOU REFERRED TO US?

	Yes	No
Do you work, or have you ever worked in the Child Care Industry?
Do you know of anything which would obstruct your obtaining employment in the child care industry?
Have you ever worked in a facility or with a company that has had a license revoked, and their license suspended in any State or has been the subject of a disciplinary action or incurred a tine during your employment in that facility/company?
Have you ever worked with a company that filed for bankruptcy?

What is your Highest level of Education?
What is your Major?
Please Note :

This application was designed for use by professional, technical, and administrative personnel. Answer the questions to the best of your ability. All information will be treated confidentially.

TYPE OF WORK DESIRED
Indicate the position for which you are applying
Do you wish to work:

Full TimeTemporarilyIf part time, specify hours or days
What is your minimum hourly salary requirement? *
Date available to work*

MonthDayYear
Date
Do you have any commitments to another employer that might affect your employment with us?

YesNo
If Yes Explain

SKILLS
Computer Competency Level
What other languages do you speak other then English?
List of Computer software skills Mostly Used:
Other:

EDUCATIONAL DATA

	Prtnt Name, Number, Street, City, State and Zip for each	No. of yrs. Completed	Degree, Major or Type of Course
High School ( Name )
High School (Number, Street, City, State and Zip )
Collegel ( Name )
College (Number, Street, City, State and Zip)
Grad. School (Name )
Grad. School (Number, Street, City, State and Zip)
Trade, Business Night or Corr.( Name )
Trade, Business Night or Corr.(Number, Street, City, State and Zip)
Other ( Name)
Other (Number, Street, City, State and Zip)

Do you have a DCF transcript

YesNo
if yes upload a recent copy.

Cancelof
Do you have educators certificate

YesNo
if yes please UPLOAD a copy for review

Cancelof
In or current or Past job position where you a teacher or assistant teacher or floater in school

YesNo
Which position best describes your position

GENERAL INFORMATION
Are you legally authorized to work in the United States?*

YesNo
Are you below the age of 18?*

YesNo
Do you know of any reason why you can not perform the essential functions of the job for which you are applying for with or without reasonable accommodation?*

Noif yes, Explain:
Please include any other information you think would be helpful to us in considering you for employment, such as additional work experience, articles/books published, activities, accomplishments,etc. (You may exclude all information indicative of age, sex, race, religion, color, national origin or disability.)*
AGREEMENT: (Please read the following statements carefully)
I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.
I understand that the first 90 days of my employment will be considered a probationary period and that my employment can be terminated, with or without cause. at any time at the discretion of either the company or myself. I understand than no management official other than the president of the company has any authority to enter into any agreement contrary lo the foregoing or make any oral assurance of promise of continued employment.

I authorize persons, schools, my current employer (If applicable) and previous employers and organizations named In this application {and accompanying resume, If any) to provide any relevant Information that may be required to arrive at an employment decision.
I understand that I may be required to take a lie detector test at the expense of the Company. Should I refuse to take such a test, the Company may terminate my employment at will.
Name
Phone Number
Please enter a valid phone number.
Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date

EMPLOYMENT HISTORY

List present employer or most recent employer first (use additional paper, if necessary).
May we contact this employer?

YesNo
Employer Details

EmployerAddressTelephone:
Salary

Your SalaryStart End
Employed

From Mo./Yr.ToMo./Yr.
Supervisor's Name & Job Title

Supervisor's NameYour Job Title
Duties:
Reason for Leaving
May we contact this employer?

YesNo
Employer Details

EmployerAddressTelephone:
Salary

Your SalaryStart End
Employed

From Mo./Yr.ToMo./Yr.
Supervisor's Name & Job Title

Supervisor's NameYour Job Title
Duties:
Reason for Leaving
May we contact this employer?

YesNo
Employer Details

EmployerAddressTelephone:
Salary

Your SalaryStart End
Employed

From Mo./Yr.ToMo./Yr.
Supervisor's Name & Job Title

Supervisor's NameYour Job Title
Duties:
Reason for Leaving

REFERENCES (AT LEAST THREE - NOT EMPLOYERS OR RELATIVES)

	NAME & ADDRESS	OCCUPATION	RELATIONSHIP	PHONE
1.
2.
3.
4.
5.

Should be Empty:

APPLICATION FOR EMPLOYMENT

TYPE OF WORK DESIRED

SKILLS

MILITARY EXPERIENCE

GENERAL INFORMATION

EMPLOYMENT HISTORY