Employment Application

Personal Info

First Name*

Last Name*

Middle Initial*

Address*

City*

State*

ZIP*

Phone Number*

Email Address*

Are you 18 or older? YesNo

Employment Info

Are You Entitled to Work in the United States? YesNo

Have you been convicted of a felony or been incarcerated in connection with a felony in the past seven years? NoYes

If Yes, Please Explain

Position You Are Applying For*

How Did You Hear About This Position?*

Expected Hourly Rate*

Date Available*

Education

High School

Last Year Complete 9101112

Degree

Major or Emphasis

College/University

Last Year Complete 1234

Degree

Major or Emphasis

Trade School

Last Year Complete

Degree

Major or Emphasis

List Any Applicable Specials Skills, Training, or Proficiencies

Do you have TECE 1 and 2? NoYes

Do you have CDA? NoYes

Do you have Early Childhood Assistant or Teacher Certificate? NoYes

Prior Work Experience

Current or Most Recent Employer

Employer

Telephone

Name Of Supervisor

Address

City

State

ZIP

Dates of Employment (From/To)

Position/Job Title

Reason For Leaving

Pay

May We Contact YesNo

Past Employer

Employer

Telephone

Name Of Supervisor

Address

City

State

ZIP

Dates of Employment (From/To)

Position/Job Title

Reason For Leaving

Pay

May We Contact YesNo

Personal References

Reference 1

First Name

Last Name

Phone Number

Address

City

State

ZIP

Reference 2

First Name

Last Name

Phone Number

Address

City

State

ZIP

Reference 3

First Name

Last Name

Phone Number

Address

City

State

ZIP

Disclaimer - By signing, I hereby certify that the above information, to the best of my knowledge, is correct. I understand that falsification of this information may prevent me from being hired or lead to my dismissal if hired. I also provide consent for former employers to be contacted regarding work records.

Sign Here