Grace & Daycare Employee Application

Grace & Daycare Employee Application

Fill out this daycare employment application using the wording and field structure from the PDF. Match labels and options as closely as possible and keep fields optional unless the PDF clearly marks them required.
645 W Florida Avenue Beaumont, TX 77705
Last Name
First Name
Middle
Social Security Number
Street Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State
Zip
Home phone
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Are you a US citizen?
Do you have a Visa to work in the US? (if not a US citizen)
Visa number
Visa expiration date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position applied for - Preference 1
Position applied for - Preference 2
Position applied for - Preference 3
Available to work - Full time
Available to work - Part time
Available to work - Weekends
Available to work - Week days
Available to work - Mornings
Available to work - Afternoons
Available to work - Nights
Available to work - Temporary
Date Available

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Compensation desired
Are you 18 years of age or older?
Education and Training
College/Trade School 1 - Name
College/Trade School 1 - Field of Study
College/Trade School 1 - Dates Attended
College/Trade School 1 - Degree/Certificate
College/Trade School 2 - Name
College/Trade School 2 - Field of Study
College/Trade School 2 - Dates Attended
College/Trade School 2 - Degree/Certificate
Other Education - Institution
Other Education - Field of Study
Other Education - Dates Attended
Other Education - Degree/Certificate
High School - Name
High School - City/State
High School - Dates Attended
High School - Diploma received
Have you had CPR training?
CPR training - Date of training

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Have you had First Aid training?
First Aid training - Date of training

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Other childcare trainings (details and dates)
Other languages spoken fluently
Do you possess a driver's license?
Driver's license - State
Driver's license - Number
Skills and abilities beneficial to daycare
Employment History and References
Employer Name 1
Dates of Employment 1
Street Address 1
City/State/Zip 1
Phone Number 1
Please enter a valid phone number.Format: (000) 000-0000.
Job Title 1
Supervisor Name 1
Reason for Leaving 1
Employer Name 2
Dates of Employment 2
Street Address 2
City/State/Zip 2
Phone Number 2
Please enter a valid phone number.Format: (000) 000-0000.
Job Title 2
Supervisor Name 2
Reason for Leaving 2
Employer Name 3
Dates of Employment 3
Street Address 3
City/State/Zip 3
Phone Number 3
Please enter a valid phone number.Format: (000) 000-0000.
Job Title 3
Supervisor Name 3
Reason for Leaving 3
Employer Name 4
Dates of Employment 4
Street Address 4
City/State/Zip 4
Phone Number 4
Please enter a valid phone number.Format: (000) 000-0000.
Job Title 4
Supervisor Name 4
Reason for Leaving 4
Employer Name 5
Dates of Employment 5
Street Address 5
City/State/Zip 5
Phone Number 5
Please enter a valid phone number.Format: (000) 000-0000.
Job Title 5
Supervisor Name 5
Reason for Leaving 5
Name 1
Address 1
Phone 1
Please enter a valid phone number.Format: (000) 000-0000.
Years known 1
Name 2
Address 2
Phone 2
Please enter a valid phone number.Format: (000) 000-0000.
Years known 2
Name 3
Address 3
Phone 3
Please enter a valid phone number.Format: (000) 000-0000.
Years known 3
Background and Acknowledgement
May we contact all previous employers?
If no, please explain
Do you have a criminal record?
Criminal record - Explanation
While employed in a childcare program have you ever been the subject of disciplinary action?
Disciplinary action - Explanation
Acknowledgement - Printed Name
Acknowledgement - Signature
Acknowledgement - Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Grace & Daycare Employee Application

645 W Florida Avenue Beaumont, TX 77705

Education and Training

Employment History and References

Background and Acknowledgement