PREVIOUS EMPLOYMENT (List below your last four employers, starting with the most recent)

 

Which of these jobs did you like best? ________________________________________________________________________

What did you like most about this job?

________________________________________________________________________

List any special talents or hobbies: ________________________________________________________________________

What organizations do you belong to (Educational or Professional):

________________________________________________________________________

What age group do you enjoy working with most?

________________________________________________________________________

On which of the following do you have current training?

___ CPR                     ___ First Aid             ___Food Handlers Permit

___ HIV Training     Have you had a current TB test? ____________

What contributions could you bring to our program?

________________________________________________________________________

________________________________________________________________________

REFERENCES

Give the names of three persons not related to you, whom you have known at least one year.

PROFESSIONAL REFERENCES

 

PERSONAL REFERENCES

 

 

In case of emergency notify: ________________________________________________

                                                Name                                                               Phone

 

Have you ever been convicted of a crime or felony? □No □Yes:____________________

Do you object to being fingerprinted? □No □Yes

 

            I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.

            In consideration of my employment, I agree to conform to the company’s rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company’s option.  I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.  I understand that no company representative, other than it’s president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for and specific period of time, or to make any agreement contrary to the foregoing.

 

Date _______________________     Signature__________________________________