Baby Love Daycare & Learning Center Employee Application

Baby Love Daycare & Learning Center Employee Application

Complete the application using the fields and order extracted from the PDF.
Application Details
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Position Desired
Program Name
Date Available

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Interviewed By
Personal Information
Name

First NameMiddle NameLast Name
Spouse’s Name

First NameMiddle NameLast Name
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
National ID Number
Eligibility and Background
If you are under age 18, can you submit a work permit if hired?
If you are not a U.S. citizen, do you have authorization to work in the U.S.?
Has bond or security clearance ever been denied and/or canceled?
If yes, what kind of visa classification do you have?
Visa registration number
Visa expiration date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
If yes, please explain
Education History
Elementary School - Place
Elementary School - Dates
Elementary School - Diploma/Certificate/Degree
Secondary School - Place
Secondary School - Dates
Secondary School - Diploma/Certificate/Degree
College - Place
College - Dates
College - Diploma/Certificate/Degree
Other Education - Place
Other Education - Dates
Other Education - Diploma/Certificate/Degree
Experience and Training
Experience with groups of children (ages, duties, dates, reasons for leaving)
Have you attended/completed any child care training courses? (Page 1)
If yes, list child care training courses (Page 1)
Have you attended/completed any child care training courses? (Page 2)
Employment History
Employment History Entry 1 - From (Month/Year)
Employment History Entry 1 - To (Month/Year)
Employment History Entry 1 - Name and Address of Employer
Employment History Entry 1 - Position
Employment History Entry 2 - From (Month/Year)
Employment History Entry 2 - To (Month/Year)
Employment History Entry 2 - Name and Address of Employer
Employment History Entry 2 - Position
Employment History Entry 3 - From (Month/Year)
Employment History Entry 3 - To (Month/Year)
Employment History Entry 3 - Name and Address of Employer
Employment History Entry 3 - Position
Employment History Entry 4 - From (Month/Year)
Employment History Entry 4 - To (Month/Year)
Employment History Entry 4 - Name and Address of Employer
Employment History Entry 4 - Position
Employment History Entry 5 - From (Month/Year)
Employment History Entry 5 - To (Month/Year)
Employment History Entry 5 - Name and Address of Employer
Employment History Entry 5 - Position
Additional Qualifications and Declarations
Do you have a criminal record?
If yes, please explain the criminal record
History of abuse, neglect, or serious injury finding?
Able to adequately perform the job duties as described?
If no, please explain your ability to perform the duties
Do you have a valid driver’s license?
Driver’s license number and class
CPR training within the past two years?
CPR training date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
First aid training within the past three years?
First aid training date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Willing to participate in required annual child care training?
Signature
Applicant Signature
Application Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
10-Year Employment History
Social Security Number
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
From (Month/Year) - Employment Record 1
To (Month/Year) - Employment Record 1
Name and Address of Employer - Employment Record 1
Position - Employment Record 1
Reason for Leaving - Employment Record 1
From (Month/Year) - Employment Record 2
To (Month/Year) - Employment Record 2
Name and Address of Employer - Employment Record 2
Position - Employment Record 2
Reason for Leaving - Employment Record 2
From (Month/Year) - Employment Record 3
To (Month/Year) - Employment Record 3
Name and Address of Employer - Employment Record 3
Position - Employment Record 3
Reason for Leaving - Employment Record 3
From (Month/Year) - Employment Record 4
To (Month/Year) - Employment Record 4
Name and Address of Employer - Employment Record 4
Position - Employment Record 4
Reason for Leaving - Employment Record 4
From (Month/Year) - Employment Record 5
To (Month/Year) - Employment Record 5
Name and Address of Employer - Employment Record 5
Position - Employment Record 5
Reason for Leaving - Employment Record 5
From (Month/Year) - Employment Record 6
To (Month/Year) - Employment Record 6
Name and Address of Employer - Employment Record 6
Position - Employment Record 6
Reason for Leaving - Employment Record 6
From (Month/Year) - Employment Record 7
To (Month/Year) - Employment Record 7
Name and Address of Employer - Employment Record 7
Position - Employment Record 7
Reason for Leaving - Employment Record 7
From (Month/Year) - Employment Record 8
To (Month/Year) - Employment Record 8
Name and Address of Employer - Employment Record 8
Position - Employment Record 8
Reason for Leaving - Employment Record 8
From (Month/Year) - Employment Record 9
To (Month/Year) - Employment Record 9
Name and Address of Employer - Employment Record 9
Position - Employment Record 9
Reason for Leaving - Employment Record 9
From (Month/Year) - Employment Record 10
To (Month/Year) - Employment Record 10
Name and Address of Employer - Employment Record 10
Position - Employment Record 10
Reason for Leaving - Employment Record 10
Should be Empty:

Baby Love Daycare & Learning Center Employee Application

Application Details

Personal Information

Eligibility and Background

Education History

Experience and Training

Employment History

Additional Qualifications and Declarations

Signature

10-Year Employment History