Employment

    Online Employment Application


    Position Applying For:
    Expected Rate Of Pay:

    Name (required):

    Email (required)

    SSN# (required)

    Phone# (required)

    Current Address


    Address (required):

    City (required):

    State (required):

    Zip (required):

    How Long Were You At This Address? (required):

    Years:

    Months:

    Previous Address


    Address:

    City:

    State:

    Zip:

    How Long Were You At This Address? :

    Years:

    Months:

    Availability

    What shifts are you available:

    Are You Applying For:

    Available Weekends?


    Background Information

    Have 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?

    Have you ever failed a drug test?

    Are you willing to take a drug test?

    Have you ever been charged with a DWI/DUI?


    Certification Information

    Are you certified in CPR?

    First Aid?

    PAPH?

    Medication?

    Are You Willing to provide these certifications to Kidz Harbor?

    Describe any other Certifications or special training your have which you feel is pertinent to child care. Include any continuing education which you have received.

    Education

    Name of School:

    Dates Attended:

    Graduate?

    Location: City and State

    Type of Diploma

    Major Field of Study

    Education

    Name of School:

    Dates Attended:

    Graduate?

    Location: City and State

    Type of Diploma

    Major Field of Study

    Employment History

    List 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/End

    Supervisor Name

    Supervisor Phone

    Address:

    Reason For Leaving

    Salary:

    Company:

    Dates Employed: Start/End

    Supervisor Name

    Supervisor Phone

    Address:

    Reason For Leaving

    Salary:

    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.