Simple Job Application Form

Application for Employment

Please complete the form below to apply for a position with us.
Date of Application:
Full Name*

First NameMiddle NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address*
Home Number

Area CodePhone Number
Mobile Number

Area CodePhone Number
Social Security Number
NC Driver's License Number
Have you ever had a department of Social Service (DSS) substantiation?
If yes list county, state, and give the date and explain fully above. The offense(s) and how recently you were convicted, will be evaluated in related to the job for which you are applying.
Have you ever been convicted of breaking a law other than minor traffic violation?
If yes, please explain above.
Position you are applying for*
Desired hourly pay rate?
EDUCATION
Highest Level of Education?
High School Attended
Did you graduate?
College Attended
Type of Degree-Major
Did you graduate?
Work History
Employer

Name of Employer

Dates of Employment

SupervisorPhone Number

Job Title
Description of Job Duties
Employer

Name of Employer

Dates of Employment

SupervisorPhone Number

Job Title
Description of Job Duties
Employer

Name of Employer

Dates of Employment

SupervisorPhone Number

Job Title
Description of Job Duties
Child care training you have completed in the last three years (such as first aid, CPR, CDA, ITS-SIDS, etc.):
How many years of experience do you have working in early childhood?
How many credit hours do you have?
Please share additional credentials below
Upload Resume*

Upload a File

Cancelof
Available Start Date

MonthDayYear
List References Below (name, phone numbers and addresses of each)
Reference 2
Reference 3
I certify that I have given true, accurate, and complete information on this form to the best of my knowledge. In the event confirmation is needed in connection with my work, I authorize educational institutions, associations, registrations, and licensing boards, and others to furnish whatever detail is available concerning my qualifications.

I authorize investigations of all statements made in this application and understand that false information of documentation or failure to disclose relevant information may be grounds for rejection of my application, disciplinary action, or dismissal if I am employed and (or) criminal action. I further understand that dismissal on unemployment shall be mandatory if fraudulent disclosures are given to meet position qualifications. dit this text...
Submit Electronic Signature

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Date

MonthDayYear
Should be Empty:

Application for Employment

EDUCATION

Work History