Employment Application

Childcare Discovery Center
Employment Application
Applicant Information
Full Name
Date

MonthDayYear
Date
Street Address
City
State
ZIP Code
Phone Number
Please enter a valid phone number.
Email
Date Available

MonthDayYear
Date
Social Security No.
Date of Birth

MonthDayYear
Date
Position Applied For:

AideAssistant TeacherLead Teacher
Part Time or Full Time:

Part Time (between the hours of 12pm-6pm)Full Time (between the hours of 5:30am-6pm)
Are you a citizen of the United States:?

YesNo
If no, are you authorized to work in the U.S.?

YesNo
Do you have children who would need childcare while you are working?

Yes 1No
If yes, list ages of children
Have you ever been convicted of a felony?

YesNo
If yes,explain
Education
High School
Address
From
To
Did you graduate?

YESNO
Diploma
College
Address
From
To
Did you graduate?

YESNO
Degree
Other
Address
From
To
Did you graduate?

YESNO
Degree
References
Please list three professional references.
Full Name
Relationship
Company
Phone
Address
Full Name
Relationship
Company
Phone
Address
Full Name
Relationship
Company
Phone
Address
Previous Employment
Company
Phone
Address
Supervisor
Job Title:
Responsibilities
Starting Salary
Ending Salary
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?

YESNO
Company
Phone
Address
Supervisor
Job Title
Responsibilities
Starting Salary
Ending Salary
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?

YESNO
Company
Phone
Address
Supervisor
Job Title
Responsibilities
Starting Salary
Ending Salary
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?

YESNO
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Childcare Discovery Center

Employment Application

Applicant Information

Education

References

Previous Employment

Disclaimer and Signature