Employment Application
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
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Date Available
*
-
Month
-
Day
Year
Date
Which position are you applying for?
*
Are you 16 years of age or older?
*
Yes
No
Are you 20 years of age or older?
*
Yes
No
Are you a citizen of the United States?
*
Yes
No
Have you ever worked for this company?
*
Yes
No
If yes, please explain.
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Education
Name of High School
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Did you graduate?
Yes
No
Degree
Do you have a college education?
*
Yes
No
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Education
Name of College/University
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Did you graduate
Yes
No
What was your degree?
Do you have any other schooling?
*
Yes
No
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Other Schooling
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Did you graduate?
Yes
No
Degree
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1st Reference
Name
First Name
Last Name
Relationship
Company
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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2nd Reference
Name
First Name
Last Name
Relationship
Phone Number
Please enter a valid phone number.
Company
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have previous employment?
*
Yes
No
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Recent Previous Company
Recent Previous Company
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor Name
First Name
Last Name
Job Title
Responsibilities
Date Started
-
Month
-
Day
Year
Date
Date Ended
-
Month
-
Day
Year
Date
Reason for leaving
May we contact your previous supervisor for a reference?
Yes
No
Do you have a second previous employment?
*
Yes
No
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2nd Previous Company
2nd Previous Company
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor Name
First Name
Last Name
Job Title
Responsibilities
Date Started
-
Month
-
Day
Year
Date
Date Ended
-
Month
-
Day
Year
Date
Reason for Leaving
May we contact your previous supervisor for a reference?
Yes
No
Do you have a third previous employment?
*
Yes
No
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3rd Previous Company
3rd Previous Company
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor Name
First Name
Last Name
Job Title
Responsibilities
Date Started
-
Month
-
Day
Year
Date
Date Ended
-
Month
-
Day
Year
Date
Reason for Leaving
May we contact your previous supervisor for a reference?
Yes
No
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Do you have any military service?
*
Yes
No
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Military Service
Branch
Date Started
-
Month
-
Day
Year
Date
Date Ended
-
Month
-
Day
Year
Date
Rank at Discharge
Type of Discharge
If other than honorable, explain.
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Completed Trainings & College Courses
First Aid Certified?
*
Yes
No
School Age Child Care Class
*
Yes
No
Elementary Education Classes
*
Yes
No
Child Growth & Development Class
*
Yes
No
CPR Certified
*
Yes
No
Child Care Administration Class
*
Yes
No
Educational Psychology
*
Yes
No
Child Psychology
*
Yes
No
Intro to Psychology
*
Yes
No
Adolescent Psychology
*
Yes
No
Children's Literature
*
Yes
No
Literacy in Early Childhood
*
Yes
No
Processes & Acquisitions of Reading
*
Yes
No
Human Growth & Development
*
Yes
No
List any other Education/Psychology/Childcare classes you have taken:
*
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Work Schudule
Staff Hours:
Dependent on School Bell Schedule
Morning Shift
Afternoon Shift
Start Time: 6:30/6:45am
Start Time: 1:45/2:30/3:30pm
End Time: 9am
End Time: 5:30/5:45/6:15/6:30pm
I am available the following days
*
Monday
Tuesday
Wednesday
Thursday
Friday
Monday AM Hours
Monday PM Hours
Tuesday AM Hours
Tuesday PM Hours
Wednesday AM Hours
Wednesday PM Hours
Thursday AM Hours
Thursday PM Hours
Friday AM Hours
Friday PM Hours
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Work Schedule (Part 2) & Signature
List below classes you are presently taking:
I would like to work approximately this many hours per week:
*
Please Select
10 hours
15 hours
20 hours
25 hours
30 hours
35 hours
40 hours
Check the areas you would like to work
Eldersburg
Finksburg
Glyndon
Manchester
Mt. Airy
Westminster
Signature
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: