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Employment Application
THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT
but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 3 years.
Positions
Position Applied For:
- Select Position -
1 - Teacher
2 - Director
3 - Lead Teacher
5 - Dietician/Cook
6 - Bus Driver
7 - Assistant Director
8 - Substitute
Personal
First Name:
Middle Name:
Last Name:
Home Phone:
Work Phone:
Cell Phone:
Email Address:
Addresses
Current Address
Street:
City:
State:
Zip Code:
Since (Mo/Yr):
Prior Address
Street:
City:
State:
Zip Code:
Since (Mo/Yr):
To (Mo/Yr):
Prior Address
Street:
City:
State:
Zip Code:
Since (Mo/Yr):
To (Mo/Yr):
Education
High School
School:
City:
State:
Diploma:
No
Yes
Undergrad School
School:
City:
State:
Diploma:
No
Yes
Deg/Cert/Dip:
Area of Study:
Grad School
School:
City:
State
Diploma:
No
Yes
Deg/Cert/Dip:
Area of Study:
Other School
School:
City:
State:
Diploma:
No
Yes
Deg/Cert/Dip:
Area of Study:
Employment
Employment Information
Position Applied For:
Do You Prefer:
Full-Time
Part-Time
Either
Available:
M
Tu
W
Th
F
Sa
Su
Please answer all of the following questions.
1) Are you at least 18 years of age and legally eligible to work for our company in the United States?
No
Yes
If you are under 18 years of age, can you provide required proof of your eligibility to work?
No
Yes
2) Have you worked for this business before?
No
Yes
If yes, please provide dates and locations.
3) Have you ever been convicted of a crime involving any child such as abuse or neglect?
No
Yes
4) Do you have any questions about the job requirements and training requirements to work in child care in North Carolina?
No
Yes
If yes, please explain
5) Are you on layoff and subject to recall?
No
Yes
6) Are you currently bound by a noncompetition, confidentiality or trade secret agreement?
No
Yes
If yes, please explain...
7) Have you ever been discharged or asked to resign from a job?
No
Yes
If yes, please explain...
8) Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?
No
Yes
If yes, please explain...
Employers
Are you currently employed?
No
Yes
May we contact your present employer?
No
Yes
Most Recent Employer
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay upon leaving:
Supervisor:
Duties:
Reason For Leaving:
Prior Employer
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay upon leaving:
Supervisor:
Duties:
Reason For Leaving:
Prior Employer
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay upon leaving:
Supervisor:
Duties:
Reason For Leaving:
Prior Employer
Employer:
City:
State:
Zip Code:
Phone:
Position Held:
From (m/yyyy):
To (m/yyyy):
Pay upon leaving:
Supervisor:
Duties:
Reason For Leaving:
Skills
Job-related Skills
Please answer the following questions if the position you are applying for requires driving a motor vehicle:
1) Do you have a valid driver's license?
No
Yes
If yes, Driver's License Number:
Date of Issue:
2) Have you been convicted of or pled guilty to any traffic-related offense within the past five years?
No
Yes
If yes, please explain...
3) Have you had your driver's license suspended or revoked or had your driving privileges modified by a court of law?
No
Yes
If yes, please explain...
4) Please list all states from which you hold or held a driver's license:
Skills
Professional Designations
References
Reference
Name:
Address:
Telephone:
Relationship:
Years Acquainted:
Reference
Name:
Address:
Telephone:
Relationship:
Years Acquainted:
Reference
Name:
Address:
Telephone:
Relationship:
Years Acquainted:
Reference
Name:
Address:
Telephone:
Relationship:
Years Acquainted:
Resumes
Resume (Text Version)
Copy and Paste a text version of your resume here.
Upload File
Attach a file to your application submission
(Permitted File Types: doc,docx,pdf,txt - Max file size: 1045876 bytes)
Agreement
Applicant Certification Agreement
1. The company and other persons or employers are released from all liability brought forth by any investigation resulting from my submission of this electronic application and the data contained here in.
2. The information in this application is true and complete to the best of my knowledge. Any falsification, misrepresentation, or omission on this application can be cause for denial or termination of employment.
3. If hired, my employment is voluntary, meaning that either party can employment at any time for any reason. Upon acceptance of employment if a position is offered, I agree to abide by all existing and future company rules and regulations. The company reserves the right to change any working agreement as deemed necessary.
4. Any employment offer is contingent open my providing proof of identity and eligibility to work the country of employ.
5. I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.
6. I understand that by typing my name in the signature box below and submitting this application electronically, this becomes a legal and binding contract.
Security Code
Security Code
Signature
Type Name in Signature Box:
Date:
2023-03-31 21:15:32
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