Employment Application

Today's Date:


Applying for: Full-TimePart-TimeTemporary


Position Applying for:


How did you hear about us:


Date available for employment:


Your Full Name:


Current Address:


City: State: Zip:


Contact & Other Information:


Home Phone:


Cell Phone:


Email:


Us CItizen: YesNo


Do you have a Soc. Sec. Number?: YesNo


Date of Birth:


Employment History



1) Current or Most Recent Employer :


Your Position:


How Long? From: to:


Starting Wage:


Employers Address:


Employer’s Phone:


Contact Person:


Reason for leaving or looking for other job:



2) Previous Employer :


Your Position:


How Long? From: to:


Starting Wage:


Employers Address:


Employer’s Phone:


Contact Person:


Reason for leaving or looking for other job:



3) Previous Employer :


Your Position:


How Long? From: to:


Starting Wage:


Employers Address:


Employer’s Phone:


Contact Person:


Reason for leaving or looking for other job:


Personal References (3)


(1) Name Phone:


Relationship How Long?


(2) Name Phone:


Relationship How Long?


(3) Name Phone:


Relationship How Long?


Education:


Highest Grade Level Completed:


(High School) 91011GradGED


(College) 1234 Degree:


Tell me about all applicable education and classes completed.



Tell me about any experience you have working with children.



What ages of children are you most comfortable working with?


Are you trained in Pediatric CPR and 1st Aid? YesNo


Are you willing to participate in ongoing training? YesNo


Are you currently enrolled in the Oregon Criminal History Registry? YesNo


(note: you will not be eligible for an interview without being enrolled in the registry)
PLEASE DO NOT LINK YOURSELF TO OUR CHILD CARE.


Registry Number: Expires:


Have you ever been convicted of a crime? YesNo


If Yes, please explain:


Are you willing to take a urinalysis for drug testing? YesNo


Are you able to perform all the required functions of this position? YesNo


If No, please explain :


I have answered these application questions fully and honestly and would like to be considered for a position at My Bundle of Joy. You have my permission to check all references and verify all information given here. (Please fill-in your Full Name)


Signed: Date: