KLC Before and After Care Program Application

KLC Application for Employment

Before/After School Program (Complete all sections and submit electronically)
Applicant Information
Full Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State
ZIP
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Are you 18 years of age or older?
Date Available to Begin

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Which shift(s) are you available to work?
Days Available
Can you consistently report to work at the scheduled start time?
Do you have reliable transportation to and from work?
Education
Highest Level Completed

Other
Highest Level Completed - Other
School/College
Experience with Children
Have you previously worked or volunteered with children?
If yes, briefly describe
Areas of Experience

Other
Areas of Experience - Other
Age Groups
Certifications & Training

Other
Certifications & Training - Other
Employment History
Most Recent Employer - Employer
Most Recent Employer - Position
Most Recent Employer - Dates Employed
Most Recent Employer - Supervisor
Most Recent Employer - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Most Recent Employer - Reason for Leaving
Previous Employer - Employer
Previous Employer - Position
Previous Employer - Dates Employed
Previous Employer - Supervisor
Previous Employer - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Previous Employer - Reason for Leaving
References
Reference 1 - Name

First NameMiddle NameLast Name
Reference 1 - Relationship
Reference 1 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference 1 - Email
example@example.com
Reference 2 - Name

First NameMiddle NameLast Name
Reference 2 - Relationship
Reference 2 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2 - Email
example@example.com
Position Responsibilities & Agreements
Assist children with homework and activities
Supervise children during indoor and outdoor activities
Assist with serving snacks
Assist with maintaining a clean and safe environment
Supervise students during school bus arrival/departure
Are you willing to complete the required background-check process?
Applicant Acknowledgment
Applicant Signature
Date

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

KLC Application for Employment

Applicant Information

Education

Experience with Children

Employment History

References

Position Responsibilities & Agreements

Applicant Acknowledgment