Childcare Employment Application


Posted on May 4, 2012 by admin | in Uncategorized

PLEASE USE AN INK
PEN AND PRINT ALL
FIELDS EXCEPT
SIGNATURE

CHILDCARE EMPLOYMENT APPLICATION FORM
Date received:

By:



PLEASE COMPLETE PAGES 6-10 DATE ___________________________

Name ___________________________________________________
Last First Middle Other Names  
Present address ___________________________________________________
Number Street City State Zip
How long at current address:_________________________________          Social Security No. ______-______-______

ITIN No. _________________ (registered aliens)

Telephone (          ) Cell Phone (          ) Other Telephone (          )

Are you under age 18 _____YES _____NO, if “YES”, Do have proof of your eligibility? _____YES _____N0

Are you currently authorized to work in the United States? ____YES _____NO

Position applied for (1) _____________________ Days/hours available to work

How many hours can you work weekly? ______________________

Employment desired
FULL-TIME ONLY
PART-TIME ONLY
LIVE-IN
LIVE-OUT

When are you available to start work?_________________ Other Information: _____________________

DO YOU HAVE A DRIVER’S LICENSE?

Yes

No

What is your means of transportation to work? Type Year

Driver’s license
number ____________________________ State of issue _______

Operator

Commercial (CDL)

Expiration date _____________________

Have you had any accidents during the past three years? How many? _______________

Have you had any moving violations during the past three years? How Many? __________________

If you are driving your vehicle with children, is it insured?

Yes

No

Name of Company

Policy No. and Limits

Ability to drive a stick shift?

Yes

No


Please list two references other than relatives.

Name ____________________ Name ____________________
Position ____________________ Position ____________________
Company ____________________ Company ____________________
Address ____________________ Address ____________________
____________________ ____________________
Telephone ____________________ Telephone ____________________


MILITARY
HAVE YOU EVER BEEN IN THE ARMED FORCES?
Yes
No
ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?
Yes
No
Specialty___________________________ Date Entered __________________________ Discharge Date ______________________

Work Experience
Please list your work experience for the past seven years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.


Name of employer Address Name of last supervisor Employment Dates Pay or salary
City, State, Zip Code Landline Phone number (no cell) From:
To:		 Start
Final
Your Last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of employer Address Name of last supervisor Employment Dates Pay or salary
City, State, Zip Code Landline Phone number (no cell) From:
To:		 Start
Final
Your Last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Name of employer Address Name of last supervisor Employment Dates Pay or salary
City, State, Zip Code Landline Phone number (no cell) From:
To:		 Start
Final
Your Last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Name of employer Address Name of last supervisor Employment Dates Pay or salary
City, State, Zip Code Landline Phone number (no cell) From:
To:		 Start
Final
Your Last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION

(Complete mailing address)

NUMBER OF YEARS COMPLETED

MAJOR & DEGREE
High School        
         
College        
         
Bus. or Trade School        
         
Professional School        
         

May we contact your present employer?
Yes
No
Did you complete this form yourself?
Yes
No		 If NOT, who did? ___________________
If there is any additional information please attach to the following form.

(Employer)______________________is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color,
religion, gender, sexual orientation, national origin, citizenship, age or disability.
We assure you that your opportunity for employment with __________________________ depends solely on qualifications.
I understand if information contained in this application contains misleading, erroneous or deceptive information,
I will be eliminated from further consideration. I have never been convicted of abuse, neglect or been the subject of a substantiated claim of abuse or neglect regarding children.
I further attest that while caring for children I will not consume or take any alcohol or narcotics or any other substance that may impair my ability to care for children.
___________________________
Signature of Applicant 		___________________________
Date


ADDITIONAL INFORMATION SHEET FROM APPLICATION:

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