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Submit a General Application

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Attachments
Resume:
Supported formats: Word, PDF, RTF, Text, and HTML.
  - or Upload from:
 
Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
Excel Application for Employment
PERSONAL INFORMATION
Social Security Number:
* Date of Birth:
* Driver's License Number:
* Have you ever been convicted of breaking a law other than a minor traffic violoation?
Yes   No
If yes, please give date and explain fully:
* Have you ever had a Department of Social Services (DSS) substantiation?
Yes   No
If yes, list the County and/or State, give the date and explain fully:
The offense(s) and how recently you were convicted will be evaluated in relation to the job for which you are applying.

EDUCATION
* Enter the highest grade level completed:
Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

Schools Name & Location Dates Attended Course of Study Degree/Diploma
High School  To 
 To 
College or University  To 
 To 
 To 
 To 
 To 
Graduate or Professional  To 
 To 
Educational, Vocational Schools, etc.  To 
 To 
 To 
 To 

Child care training you have completed in the last three years (such as first aid, CPR, CDA, ITS-SIDS, etc.):

REFERENCES List the names, addresses and phone numbers of two people we may contact as references:

Name Address Phone Number

WORK HISTORY
List child care/early childhood experience first.

EMPLOYER 1

Employer Name Employer Address Employer Phone
Job Title Supervisor Name & Title No. Supervised by You

Dates Employed Starting Salary Ending Salary
From:

To:
Responsibilities Reason for Leaving May we contact this employer
Yes
No
Full Time Years Months
 
Part Time Years Months
 
If part time, number of hours per week

EMPLOYER 2

Employer Name Employer Address Employer Phone
Job Title Supervisor Name & Title No. Supervised by You

Dates Employed Starting Salary Ending Salary
From:

To:
Responsibilities Reason for Leaving May we contact this employer
Yes
No
Full Time Years Months
 
Part Time Years Months
 
If part time, number of hours per week


AUTHORIZATION
I certify that I have given true, accurate, and complete information on this form to the best of my knowledge. In the event confirmation is needed in connection with my work, I authorize educational institutions, associations, registration, and licensing boards, and others to furnish whatever detail is available concerning my qualifications. I authorize investigations of all statements made in this application and understand that false information of documentation, or a failure to disclose relevant information may be grounds for rejection of my application, disciplinary action, or dismissal if I am employed, and (or) criminal action. I further understand that dismissal on unemployment shall be mandatory if fraudulent disclosures are given to meet position qualifications.

* Signature (type name):
* Date:
Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The Information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender:
Female
Male
I Choose Not to Respond
Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond

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