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Love Working with Kids???

Application for Employment

Our policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental disability, or veteran status.

Date:		(mm/dd/yyyy)
Last name:
First name:
Middle name:
Street Address:
City:
State:
Zip:
Telephone:
Social Security # :
Position Applied for :
How did you hear of this opening? :
When can you start? :
Desired Wage $:
Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis?:
You may be required to provide documentation.		Yes No
Are you looking for full-time employment?		Yes No
If no, what hours are you available? :
Are you willing to work night shift?		Yes No
Have you ever been convicted of a felony?		Yes No
Are you free of drugs and illegal substances?		Yes No
Are you currently First Aid and CPR certified?		Yes No
If No, are you willing to obtain this certification prior to beginning work?		Yes No

EDUCATION

High School Name and Location :
Year and Major Degree:
College Name and Location :
Year and Major Degree:
Other Training and Location :
Year and Major Degree:
In addition to your work history, are there other skills, qualifications, or experience that we should consider?


EMPLOYMENT HISTORY (Start with most recent employer)

Company Name :
Address:
Telephone:
Date Started :
Starting Wage :
Starting Position :
Date Ended :
Ending Wage:
Ending Position:
Name of Supervisor:
May we contact?		Yes No
Responsibilities:
Reason for leaving :
Company Name:
Address:
Telephone:
Date Started :
Starting Wage :
Starting Position :
Date Ended :
Ending Wage:
Ending Position:
Name of Supervisor:
May we contact?		Yes No
Responsibilities:
Reason for leaving :
Company Name:
Address:
Telephone:
Date Started :
Starting Wage :
Starting Position :
Date Ended :
Ending Wage:
Ending Position:
Name of Supervisor:
May we contact?		Yes No
Responsibilities:
Reason for leaving :

PERSONAL REFERENCES

Name And Phone:
Years of Aquaintance And Relationship:
Name And Phone:
Years of Aquaintance And Relationship:
Name And Phone:
Years of Aquaintance And Relationship:
Shirt Size:
Energy Level?:		High About Medium Low
Honesty?:		High About Medium Low
Patience?:		High About Medium Low
Reliability?:		High About Medium Low
Punctuality?:		High About Medium Low
Standards?:		High About Medium Low
I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history. I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing.