Employment Online Employment Application Position Applying For: Expected Rate Of Pay: Name (required):Email (required)SSN# (required)Phone# (required) Current AddressAddress (required):City (required): State (required): Zip (required): How Long Were You At This Address? (required):Years:Months: Previous AddressAddress:City:State:Zip:How Long Were You At This Address? :Years:Months: AvailabilityWhat shifts are you available: 7am-3pm3pm-11pm11pm-7amAre You Applying For:Part TimeFull TimeTemporaryAvailable Weekends?YesNo Background InformationHave You Ever Been Convicted of a Felony?Have You Ever Refused a Bond?Have you ever been convicted of a misdemeanor, other than a traffic violation?YesNoYesNoYesNoHave you ever failed a drug test?Are you willing to take a drug test?Have you ever been charged with a DWI/DUI?YesNoYesNoYesNo Certification InformationAre you certified in CPR?First Aid?PAPH?Medication?YesNoYesNoYesNoYesNoAre You Willing to provide these certifications to Kidz Harbor? YesNoDescribe any other Certifications or special training your have which you feel is pertinent to child care. Include any continuing education which you have received. EducationName of School:Dates Attended:Graduate?YesNoLocation: City and StateType of DiplomaMajor Field of StudyEducationName of School:Dates Attended:Graduate?YesNoLocation: City and StateType of DiplomaMajor Field of StudyEmployment HistoryList in sequence beginning with you represent employer and account for all employers with whom you worked the last 10 years. Describe briefly the top elf work performed at each place of employment. Include company name, address, supervisor’s name and phone, reason for leaving and salary.Company:Dates Employed: Start/EndSupervisor NameSupervisor PhoneAddress:Reason For LeavingSalary:Company:Dates Employed: Start/EndSupervisor NameSupervisor PhoneAddress:Reason For LeavingSalary:By Clicking send you acknowledge that all information submitted is true. You Understand that any willfull untrue statement made in this application may be cause for termination of employment if hired by Kidz Harbor.Δ