APPLETON EMPLOYMENT APPLICATION

College, University or Professional School: (Transcripts may be required)

POSITION DESIRED:
DATE AVAILABLE:
Experiences with group of children: (Indicate ages of children, your duties, dates of time you worked in this position and reasons for leaving).
Attach documentation of experience working with children.
HAVE YOU ATTENDED/COMPLETED ANY CHILD CARE TRAINING COURSES:
IF YES, LIST:
DO YOU CURRENTLY OR IN THE PAST HAD ANY RELATIVES TO WORK FOR APPLETON EARLY LEARNING CENTER?
IF YES, PLEASE GIVE NAMES:

PERIODS OF EMPLOYMENT
Describe your work experience in detail, beginning with your current or most recent job. If you have been unemployed during the any time within the past ten years, list how your time was spent, e.g. student, housewife, unemployed, etc. Use a separate block to describe each position or gap in employment. If needed, attach additional sheets, using the same format as on the application. Resumes may be attached to provide additional information.
Name of Present or Last Employer:
Address:
Phone Number:
Format: (000) 000-0000.
Your Job Title:
Supervisor's Name:
From:
To:
Hours per week:
Salary per hour
or Salary per year
Duties and Responsibilities:
Reason for Leaving:
Name of Present or Last Employer:
Address:
Phone Number:
Format: (000) 000-0000.
Your Job Title:
Supervisor's Name:
From:
To:
Hours per week:
Salary per hour
or Salary per year
Duties and Responsibilities:
Reason for Leaving:

May we contact previous employers?
BACKGROUND INFORMATION
Do you have a criminal record?
If yes, explain:
Have you ever been shown by credible evidence, e.g. a court order or jury, a department investigation or other reliable evidence to have abused, neglected or deprived a child or adult or to have subjected any person to serious injury as a result of intentional or grossly negligent misconduct?
If yes, explain:
Do you have a valid driver's license?
License Number
Class
HAVE YOU HAD CPR WITHIN THE PAST TWO YEARS?
IF YES, GIVE EXPIRATION DATE:
HAVE YOU HAD FIRST AID TRAINING WITHIN THE PAST THREE YEARS? IF YES, GIVE EXPIRATION DATE:
Do you have any physical handicap or mental health disorder, which would interfere with you ability to perform adequately the assigned job duties for which you are applying?
If yes, explain:
Citizenship
ARE YOU A U.S. CITIZEN OR ARE YOU LEGALLY AUTHORIZED TO WORK IN THE U.S?
Department of Human Resources/Bright from the Start requires annual child care training. Are you willing to participate?

Certification
I am aware that any omissions, falsifications, misstatements, or misrepresentations above may disqualify me for employment consideration and, if I am hired, may be grounds for termination at a later date. I certify that to the best of my knowledge and belief all of the statements contained herein and on any attachments are true, correct, complete, and made in good faith.
Should be Empty:

EMPLOYMENT APPLICATION