Job Application Form
What location are you applying for?
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Marion
Cedar Rapids
Hiawatha
School-Age Program
Any of the above
Full Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
How should we contact you?
*
Phone Call
E-mail
What position are you applying for?
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Before/After School Assistant (part-time)
Full-Time Childcare Assistant
Preschool Teacher for SWVPP Program (Teaching license REQUIRED)
Part-Time Childcare Assistant
Cook
Before/After School Supervisor
Lead 2's Teacher
Lead 4's Teacher
Lead 3's Teacher
Lead Tots Teacher
Lead Infant Teacher
Hourly Wage Desired
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Available start date:
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-
Month
-
Day
Year
Date
What is your current employment status?
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Employed
Unemployed
Self-Employed
Student
Are you at least 18 years of age?
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Yes
No
What is the highest level of school you have completed?
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Less than high school degree
High school degree or equivalent (e.g. GED)
Some college, no degree
Bachelor Degree
Associate Degree
Graduate Degree
What are your hours of availability
Rows
Hours Available (between 6 am-6 pm)
Monday
Tuesday
Wednesday
Thursday
Friday
Previous Empoyment Name
*
Dates employed
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position Held
*
Rate of Pay
*
Reason for leaving
*
Previous Empoyment Name
*
Dates employed
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position Held
*
Rate of Pay
*
Reason for leaving
*
Previous Empoyment Name
*
Dates employed
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position Held
*
Rate of Pay
*
Reason for leaving
*
May we contact your previous employers?
*
Yes
No
Provide 2 personal references & phone #
*
Do you have any limitations to keep you from performing childcare duties, such as diaper changing or lifting?
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Yes
No
Other
If other, (please specify)
Have you ever been covicted or charged of a crime or felony?
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Yes
No
The State of Iowa requires mandatory background checks-
*
Yes, I understand my employment is conditional based on a background check and I consent to a full background check
No, I do not consent to a full background check
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I (your name below) understand all questions and statements above, and declare that all answers and statements are true. False or misleading information is grounds for rejection of application or termination of employment.
*
Signature
*
Upon hiring, will you need childcare services through Hand In Hand, Inc.?
*
Yes
No
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