Employment Application

Last, First, M.I :*

Date of Birth:*

Phone Number*

Address, City, State, Zip*

State/Driver's License #/State ID#:*

*If "No", are you authorized to work in U.S .?*

Yes (Attach documentation)

No

Attach documentation

Max. file size: 1 GB.

Have you ever been convicted of a felony?*

Yes (If "Yes" explain) :

No

Please Explain*

Driver's License/State ID Info: (Attach copy)

Max. file size: 1 GB.

Language*

Read

Write

Language

Read

Write

I am applying for the following position(s)*

Director

Assistant Director

Teacher

Assistant Teacher

Nutrition Coordinator/Cook

Driver

Administrative Support

Volunteer

Desired Pay:*

List availability: Weekdays, Weekends, Days, and/or Nights:

List Experience related to the position(s) you are applying for:*

EDUCATION

High School:*

Address:*

Start Date:*

End Date:

Select One:*

Diploma (attach)

GED (attach)

Not Graduated

College:

Address:

Start Date:

End Date:

Select One:

Associate Degree

Bachelor Degree

No Degree, Total hours:

Other Education/Certifications received: (CPR Etc.)

MILITARY SERVICE

Branch:

From:

To:

Type of Discharge

Honorable

Dishonorable

* If other than honorable, explain:

EMPLOYMENT HISTORY

Are you a previous employee of Next Generation Child Care and Preschool?*

Yes

No

CERTIFICATIONS (Attach Copies) CPR Etc .:

Date Received:

Employer:*

Supervisor Name:*

Address:*

Telephone:*

Job Title:*

Start Date:*

End Date:*

Ending Salary: $*

Detail Responsibilities:*

Reason for Leaving:*

May we contact your previous employer/supervisor for a reference?*

Yes

No

Employer:*

Supervisor Name:*

Address:*

Telephone:*

Job Title:*

Start Date:*

End Date:*

Ending Salary: $*

Detail Responsibilities:*

Reason for Leaving:*

May we contact your previous employer/supervisor for a reference?*

Yes

No

Employer:

Supervisor Name:

Address:

Telephone:

Start Date:

End Date:

Ending Salary: $

Detail Responsibilities:

Reason for Leaving:

May we contact your previous employer/supervisor for a reference?

Yes

No

Is there anything else you would like us to know?*

REFERENCES

Provide three references (personal (non-relative) and/or professional) that can be contacted.

Reference #1 Name:

Relationship:

Phone Number:

Email:

DISCLAIMER AND ACKNOWLEDGMENT

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, understand that false or misleading information in my application or interview may result in termination.

Signature*

Date*

PLEASE NOTE: INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED FOR EMPLOYMENT

Staff Use Only:

Contacted By:

Interviewed:

Hire Date:

List

Apply for Employment

EDUCATION

MILITARY SERVICE

EMPLOYMENT HISTORY

REFERENCES

DISCLAIMER AND ACKNOWLEDGMENT

** PLEASE NOTE: INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED FOR EMPLOYMENT **

PLEASE NOTE: INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED FOR EMPLOYMENT