Application For Employment

APPLICATION FOR EMPLOYMENT IN A CHILD CARE FACILITY

Applicant's Name*

Position For Which You Are Applying*

Applicant’s Home Address

Country*

State*

City*

Zip*

Phone Number*

Are You At Least 18 Years Old?*

Yes

How Long Have You Lived At This Address?

Applicant’s Date of Birth*

Previous Address

City

Country

State

Zip

Can You Legally Work In The U.S ?

(Proof of Citizenship Or Immigration Status Wil Be Required Upon Employment)

Name of A Contact Person In Case of An Emergency*

Contact Person’s Address

City*

Country*

State*

Zip*

Relationship*

Phone Number With Area Code*

1. Have you ever held a child care license with the Department of Children and Families or been registered to provide child care in your home?*

Yes

2. While employed in a child care program, have you ever been the subject of disciplinary action, or been the party responsible for a child care facility receiving an administrative fine?*

Yes

3. Have you ever been arrested?*

Yes

PERSONAL REFERENCES AND SIGNATURE

Please list the names and addresses of three personal references.

Reference # 1

Name*

Phone*

State

City

Zip

Reference # 2

Name*

Phone*

State

City

Zip

Reference # 3

Name*

Phone*

State

City

Zip

EMPLOYMENT HISTORY

List below all present and past employment, in chronological order, of any jobs you have held during the previous (2) years or the last (3) jobs.

Employment History # 1

Place of Employment*

Address

Phone

Country

State

City

Zip

Dates of Employment

Position Held

Supervisor’s Name

May we contact them?

Reason for Leaving

Describe Job Duties

Employment History # 2

Place of Employment*

Address

Phone

Country

State

City

Zip

Dates of Employment

Position Held

Supervisor’s Name

May we contact them?

Reason for Leaving

Describe Job Duties

Employment History # 3

Place of Employment*

Address

Phone

Country

State

City

Zip

Dates of Employment

Position Held

Supervisor’s Name

May we contact them?

Reason for Leaving

Describe Job Duties

As an applicant to work in a child care facility, I understand that I must submit fingerprints and a local law check before my date of hire, and that failure to do so could result in immediate dismissal. I also understand that I must enroll and begin the 40-Hour training within (90) days of my date of hire and have met all of my training requirements within one year of my hire date unless I can produce verification that I have already attended this training. I agree that as a condition of employment I am required to maintain a clean criminal record and abide by all of the requirements under both the FS. Regarding Good Moral Character and any and all policies, laws, and regulations regarding Child Care. A failure to abide by the above specified conditions may be reflected as immediate resignation from Sports Camp, Inc.

UNDER PENALTY OF PERJURY, I SWAR AND AFFIRM THAT ALL THE INFORMATION GIVEN WITHIN THIS APPLICATION IS COMPLETE, ACCURATE, AND CORRECT.

This field should be left blank

Application For Employment