Employment Application Form

Employment Application

Today's Date

Date of Birth

First Name

Last Name

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Job Location Preference

Lindsay

Riggs

Power

Any of the locations

Days of the Week Available

Monday

Tuesday

Wednesday

Thursday

Friday

Hours Available

Please list your available start times and end times for each day of the week.

Monday: From

Tuesday: From

Wednesday: From

Thursday: From

Friday: From

Position Type

Desired Hourly Rate

Date Available To Start Work

Brief Bio

Prior Work History

Current Employer

Dates of Current Employment

Wage at Current Employer

May we contact current employer?

Current Supervisor

First Name Last Name

Previous Supervisor Phone

Reason for leaving

List any additional employers, your dates of employment, the name and supervisor's phone, the position you held, and your reason for leaving.

Education

Did you graduate?

What High School did attend? Where is the school located? Graduated, in what year?

College Attended, Dates & Location. Major or coursework studied? Did you earn a degree? What year?

Do you have your CDA?

Education, Degrees, Cerificates

What is your experience or skills working with children?

Ever been convicted of a felony?

If the above answer is yes, please explain.

Has anyone ever suggested or alleged that you are not appropriate to work with children for any reason? *

If the above answer is yes, please explain.

Have you ever been the subject of a Child Protective Services investigation?

If the above answer is yes, please explain.

Have you ever been convicted of any crime (misdemeanor or felony), or received a judgment related to child abuse, child neglect, and or unlawful sexual offenses?

If the above answer is yes, please explain.

Do you use tobacco products?

References

List 3 References, their relationship to you, and their Phone Numbers.

Reference 1 Name

Reference 1 Phone

Reference 1 Relationship to You? *

Reference 2 Name

Reference 2 Phone

Reference 2 Relationship to You? *

Reference 3 Name

Reference 3 Phone

Reference 3 Relationship to You? *

Have you ever been terminated from any position?

If the above answer is yes, please explain.

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