Application for Stacyville Kids Care

Application Form for Stacyville Kids Care

Child Care Employment Application
Full Name*

First NameLast Name
Position Applying For*
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Residential Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Educational Qualifications*
Please include highest level, School, Dates (Year From: To). Degree
Work Experience*
Please include Position and Company. Dates (Year From: To). Reason for Leaving
Skills and Certifications*
Please state any additional information you believe would be important in considering your application.
Are you currently certified in CPR or First Aid? If yes, through who and what is the expiration date?
Availability to Start*
Preferred Work Time (if any)*

Full TimePart TimeIf Part Time, AMIf Part Time, PMNo Preference
Preferred Age Preferences (if any)*

No PreferenceInfant/ToddlersTwo's/Three'sPre-SchoolMulti-Age/School Age
Have you ever filled an application with us before?*

YesNo
If Yes, when?
I have a criminal conviction (to include deferred judgments, even if discharged) of any law in any state. (If "yes” is checked, briefly explain the circumstances).*

YesNo
If Yes, please explain?
I have a founded or confirmed report of child or adult abuse in any state. (If “yes” is checked, briefly explain the circumstances).*

YesNo
If Yes, please explain?
References Name (1 professional and 1 personal reference)

First NameLast Name
Reference Contact Information
References Name (1 professional and 1 personal reference)

First NameLast Name
Reference Contact Information
Upload Resume/CV*

Cancelof
PLEASE READ AND SIGN :To the best of my knowledge, al of the information I have submitted on this application is true and complete. I understand that any omission or falsification of information will be sufficient cause for disqualification from further consideration for employment or for dismissal. I voluntarily give this organization the right to make a thorough investigation of my personal or past employment history and education, agree to cooperate in such investigation, and authorize any former employer, person, firm, or corporation to give this organization any information they may have regarding me. In consideration of this organization's review of this application, I release this organization and a l providers of information from any liability as a result of furnishing and receiving this information. I understand that any offers of employment are contingent on successful completion of the post-offer exam and background checks. I understand employment at this organization is "at will." which means employment may be terminated by the employee or by this organization at any time, with or without cause. I further understand employee benefits, terms and conditions of employment and the policies, procedures and work rules of the organization may be determined, changed and modified from time to time by this organization without limitation or agreement. I also understand any employment handbooks or manuals that may be distributed to me by this organization shall l not be construed as a contract.

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Application Form for Stacyville Kids Care