Employment Application Form

Employment Application

Fill the form below accurately indicating your potentials and suitability to job applying for.
Personal Information
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Employment Desired
Position applied for:
Start date:

MonthDayYear
Employee Classification:
Hours available:
Desired salary:
How were you referred to us?
Are you authorized to work in the U.S.?
Travel
Do you have reliable transportation?
Do you have a valid drivers license?
Do you have auto insurance?
Education
High School:
Did you graduate?
Degree/Area of study:
College/Higher Education:
Did you graduate?
Degree/Area of Study:
Would you be willing to continue your education by enrolling in courses or other training programs that may be recommended?
Please list any courses, volunteer work, hobbies or interests that would relate to the position you are applying for:
Please list any community organizations you are active in:
Former Employers (List your last three employers)
Employer 1:
Start date:
End date:
Position:
Reason for leaving:
Employer 2:
Start date:
End date:
Position:
Reason for leaving:
Employer 3:
Start date:
End date:
Position:
Reason for leaving:
May we contact your current employer?
Current employers contact information:
References
Reference #1:

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employer:
Years known:
Reference #2:

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employer:
Years known:
Reference #3:

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employer:
Years known:
Are there any physical or personal limitations on the type of work you can do with children at the center or that would affect the amount of time you can spend at work?
If yes, please explain:
Have you ever been convicted of a felony?
In compliance with the requirements of this childcare program, no person shall be hired or retained as a staff member, paid or volunteer, who has a been:

a) convicted of, admitted to, or been the subject of substantial evidence of an act of child, abuse, or child molestation;

b) used alcohol or drugs, such that it effects are apparent during working hours that children are in care;

c) been convicted of or admitted to any felony or any offense involving moral turpitude.

I am aware that a background study will be performed before I can be hired. I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal.
Applicants Signature:
Date:
Resume and Files

Cancelof
Training and Certifications
Should be Empty:

Employment Application

Personal Information

Employment Desired

Travel

Education

Former Employers (List your last three employers)

References