Employment Application

Name*

First Last

Email*

Address*

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

Phone*

Employment Desired:

Position*

Date Available*

Seeking:*

Full Time
Part Time

Days and Times Available

Education

High School*

College

Dates Enrolled

Major

Please list any courses or volunteer work that would relate to the position for which you are applying:*

Please list any hobbies or interests you have that relate to the position for which you are applying:*

Employment Summary

Please begin with the most recent

Company Name*

Dates of Employment*

Company Address*

Street Address City

Starting Salary

Ending Salary

Phone*

Supervisor*

Responsibilities*

Reason for separation of the work relationship:

Company #2 Name

Dates of Employment*

Company #2 Address*

Street Address City

Phone*

Starting Salary

Ending Salary

Supervisor*

Responsibilities*

Reason for separation of the work relationship:

References

Please list two persons, not related to you, we can contact who would be able to attest to your ability to interact with and supervise children. These references must be people you have known for at least one year.

Reference Name*

Phone*

Relationship to You*

Reference Name*

Phone*

Relationship to You*

Physical Record

How would you describe your general health?*

Any deficits in*

Vision?
Speech?
Hearing?
None

Describe briefly any previous serious illness.*

Please enter "none" or N/A if not applicable.

Are there any physical limitations on the type of work you can do with the children at the center or that would affect the amount of time you are able to work?*

Date of you last physical examination*

Have you ever been convicted of a felony?*

No
Yes

Do you have a driver's license?*

No
Yes

Transportation to work?*

No
Yes

Emergency Contact

Name*

Relationship*

Work Number

Cell Number*

SB Employment Application

Step 1 of 3

Employment Desired:

Education

Employment Summary

References

Physical Record

Emergency Contact

Written Interview Questions

General Information