|
 |
 |
|
THE CHILD'S NURTURING CENTER, INC.
TODAY'S DATE: ____/____/____ NAME: ___________________________________ BIRTHDATE: ____/____/____ ADDRESS: ________________________________ CITY: ____________________________ STATE: _____ ZIP CODE: _____________ PHONE: __________________________ CELL PHONE: ____________________________ EMAIL: __________________________ POSITION APPLIED FOR: ___________________ IN CASE OF EMERGENCY NOTIFY NAME: ________________________________ ADDRESS: ___________________________ HOME PHONE: ______________________ WORK PHONE: ______________________ CELL PHONE: _______________________ OTHER: _____________________________ WHAT PROMPTED YOU TO APPLY HERE: _____ ADVERTISEMENT
_____ OWN ACCORD _____ REFERRAL: WHOM: _______________________________
NAME OF HIGH SCHOOL: ____________________________ LOCATION: ______________ YEAR GRADUATED (OR EXPECTED DATE OF GRADUATION): ___________ NAME OF COLLEGE: _________________________________ LOCATION: ______________ MAJOR: ______________________ YEAR GRADUATED (OR EXPECTED DATE OF GRADUATION): ____________ GRADUATE SCHOOL: ________________________________ LOCATION: ______________ MAJOR: _______________________________________ YEAR GRADUATED OR EXPECTED DATE OF GRADUATION: __________________ DEGREES CURRENTLY HELD: ______________________________________________ OTHER SPECIALIZED TRAINING: ______________________________________________________________________________ ARE YOU PLANNING TO FURTHER YOUR EDUCATION? IF YES, WHEN AND WHAT FOR? _________________________________________________________________________________
DO YOU PLAY ANY MUSICAL INSTRUMENTS? _____YES _____NO IF YES, INDICATE WHICH ONES: ________________________________________________________________ DO YOU ENJOY SINGING? _____YES _____NO LIST ANY OTHER TALENTS YOU FEEL YOU ARE QUALIFIED TO TEACH OUR CLIENTS: HOW WOULD YOU DESCRIBE YOUR GENERAL HEALTH? ________________________ HAVE YOU ANY IMPAIRMENTS IN: ______HEARING _____VISION _____SPEECH PREVIOUS SERIOUS ILLNESS (DESCRIBE BRIEFLY): ______________________________________________________________________________ ______________________________________________________________________________ ARE THERE ANY PHYSICAL OR PERSONAL LIMITATIONS ON THE TYPE OF WORK YOU CAN DO WITH CHILDREN AT SCHOOL OR THE AMOUNT OF TIME YOU CAN SPEND AT WORK? ______________________________________________________________________________ ______________________________________________________________________________ DATE OF LAST PHYSICAL EXAM: ______/______/______
Please attach letters of work confirmation from any licensed child care center facilities listed below LIST YOUR LAST THREE EMPLOYERS WITH YOUR MOST RECENT FIRST: EMPLOYERS NAME: __________________________________________________
EMPLOYERS NAME: __________________________________________________
PLEASE LIST THREE, NOT INCLUDING RELATIVES OR FORMER SUPERVISORS NAME: _________________________________ ADDRESS: _____________________________ OCCUPATION: _________________________ PHONE: ______________________ NAME: _________________________________ ADDRESS: ____________________________ OCCUPATION: _______________________________ PHONE: ________________________ NAME: __________________________________ ADDRESS: ____________________________ OCCUPATION: _______________________________ PHONE: ________________________ HAVE YOU EVER BEEN FOUND GUILTY OF A CRIME OR FELONY? ____YES ____NO DO YOU OBJECT TO BEING FINGERPRINTED? _____YES _____NO AVAILABLE FOR PART TIME EMPLOYMENT? _____YES _____NO IF A TEACHER APPLICANT, ARE YOU AVAILABLE FOR SUBSTITUTE WORK? _____YES _____NO CLERICAL EXPERIENCE: _____ BOOKKEEPING _____ FILING _____CASHIER _____STATISTICS _____ CLERICAL _____ STENCIL CUTTING _____ OTHER: (PLEASE LIST) __________________________________________________ I AUTHORIZE THE PROSPECTIVE EMPLOYER TO INQUIRE AS TO MY RECORD OF ANY OR ALL PERSONS AND OF MY FORMER EMPLOYERS. IN THE EVENT OF MY EMPLOYMENT WITH THE CHILD CARE CENTER, I AGREE TO COMPLY WITH THE RULES AND THE REGULATIONS GOVERNING MY EMPLOYMENT AS OUTLINED IN THE EMPLOYEE HANDBOOK AND OTHER ADDENDUM MATERIALS. IN THE EVENT I SHOULD TERMINATE MY EMPLOYMENT, I AGREE TO FILE MY RESIGNATION TWO WEEKS PRIOR TO DATE EFFECTIVE OR LOSE THE PAY ABOVE MINIMUM WAGE ASSOCIATED WITH THAT PAY CYCLE AS A RESULT OF THE CONSEQUENCES SUFFERED BY THE COMPANY. IT IS MY UNDERSTANDING THAT THE FIRST SIX MONTHS OF MY EMPLOYMENT ARE PROBATIONARY AND IF MY SERVICES HAVE NOT PROVED SATISFACTORY, MY EMPLOYMENT MAY BE DISCONTINUED IMMEDIATELY WITHOUT PREJUDICE.
_________________________________ _____/_____/_____ APPLICANT SIGNATURE DATE ______________________________________________________________________________
DO NOT WRITE IN SPACE BELOW: FOR OFFICE USE ONLY ______________________________________________________________________________ DATE TO BEGIN WORK: _____/_____/_____ TEMPORARY _____ PERMANENT _____ PROGRAM: ____________________________ POSITION: ___________________________ REPLACES: ____________________________ SALARY: _________________________ REMARKS: ____________________________________________________________________________________ _____________________________________________________________________________________ INTERVIEWER: ___________________________________ DATE: _____/_____/_____ |