Employment Application

About You

First & Last Name

First Name

Last Name

Current Address

Permanent Address

Email Address

Phone

(###)

###

####

Date of Birth

YYYY

Social Security Number

Drivers License Number

Marital Status

Married

Single

What position are you interested in?

Date Available to Start

YYYY

Education

Name of High School

Year Graduated

Name of College (if applicable)

College Start Date (if applicable)

YYYY

College End Date (if applicable)

YYYY

Are you current in CPR & First Aid? When does certification expire?

Do you have any other special certifications?

Job History

last three jobs

Job 1

please include employer name, address, phone number, name of supervisor, dates of employment, and your duties

Job 2

please include employer name, address, phone number, name of supervisor, dates of employment, and your duties

Job 3

please include employer name, address, phone number, name of supervisor, dates of employment, and your duties

Personal References

list two references that are NOT RELATED to you and that you are not DATING who can tell us about you

Reference 1

please include name, phone numbers, and how you know them

Reference 2

please include name, phone numbers, and how you know them

Tell us why you want to work with kids & families

Tell us what activities you would attempt if you were in charge of a two year old class for an hour

Tell us about hobbies, special interests, or volunteer activities

Days & times you are available to work

Class schedule (if attending school)

Background Check

I understand that an FBI background check is required before I can begin working in a licensed child care center