Employment – Kidz Harbor

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: 7am-3pm3pm-11pm11pm-7am

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.