Please complete all required fields Name * First Name Last Name Phone * (###) ### #### Email * Address * Position applying for: * Ex: Administrative, teacher, etc. Desired Salary: * Your Working Choice * Full-Time Part-Time Other Other - Describe Preferred Hours * Current Employer: * Include: Company Name, Address, Phone#, Starting Date, Job Title: Reason for Leaving Can this employer be contacted? * Yes No Previous Employer * Include Contact Person, Phone#, Dates of Employment, Job Title Education * Highest Level, Dates, Degree/Certification, Field of Study, School Name Technical skills: * Communication skills: * Interpersonal skills: * Childcare experience/skills * Additional hobbies/skills * Reference #1 * Include Name, Phone#, Relationship Reference #2 * Reference #3 * Line IMPORTANT NOTE * By adding your name and submitting this form, you agree that if you should LEAVE EMPLOYMENT before 60 days, the expenses incurred during hiring WILL BE DEDUCTED FROM YOUR FINAL PAY. Example: Background check, New hire payroll expense, Mandatory First Aid/CPR class, Hours paid for training (Current estimate is: $384.00) I agree I do not agree (you will not be eligible for employment) I certify that the information provided on this application is true and complete to the best of my knowledge. I understand that any false statements may disqualify me from employment, or result in termination if already employed. * I certify I do not certify (you will not be eligible for employment) Applicant's Digital Signature * Thank you!