Online Employment Application -- ABC Childcare & Learning Center

PERSONAL INFORMATION

First Name:

Middle Initial:

Last Name:

Telephone #:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

E-Mail Address:

Are you legally eligible for employment in the U.S.A.?

YES NO

Are you over the age of eighteen?

YES NO

If no, state your age:

Position(s) applied for:

If your application is considered favorably, on what date will you be available for work?

Are there any other job related experiences, skills, or qualifications which will be a special benefit in the jobs for which you are applying?

Have you ever been convicted of any crime (misdemeanor or felony) in the past?

(Do not answer YES if conviction has been pardoned, annulled, expunged, sealed or impounded by a court.)

YES NO

If yes, please give the conviction date and nature of the offense:

You many be required to explain in detail about the conviction and nature of offense. A conviction record will not necessarily bar employment.

EMPLOYMENT HISTORY (1 of 4)

Name of previous employer:

Address Line 1:

Address Line 2:

City:

State:

Telephone #:

Date Started:

Date Finished:

Weekly Starting Salary:

Weekly Last Salary:

Reason for Leaving:

Name of Supervisor:

Describe the work you did:

EMPLOYMENT HISTORY (2 of 4)

Name of previous employer:

Address Line 1:

Address Line 2:

City:

State:

Telephone #:

Date Started:

Date Finished:

Weekly Starting Salary:

Weekly Last Salary:

Reason for Leaving:

Name of Supervisor:

Describe the work you did:

EMPLOYMENT HISTORY (3 of 4)

Name of previous employer:

Address Line 1:

Address Line 2:

City:

State:

Telephone #:

Date Started:

Date Finished:

Weekly Starting Salary:

Weekly Last Salary:

Reason for Leaving:

Name of Supervisor:

Describe the work you did:

EMPLOYMENT HISTORY (4 of 4)

Name of previous employer:

Address Line 1:

Address Line 2:

City:

State:

Telephone #:

Date Started:

Date Finished:

Weekly Starting Salary:

Weekly Last Salary:

Reason for Leaving:

Name of Supervisor:

Describe the work you did:

RECORD OF EDUCATION (1 of 2)

High School Name:

Address Line 1:

Address Line 2:

City:

State:

Course of Study:

Last Year Completed:

Did you graduate?

YES NO

List diploma or degree:

RECORD OF EDUCATION (2 of 2)

College Name:

Address Line 1:

Address Line 2:

City:

State:

Course of Study:

Last Year Completed:

Did you graduate?

YES NO

List diploma or degree:

PERSONAL REFERENCES (1 of 3)

Name:

Occupation:

Address Line 1:

Address Line 2:

City:

State:

Telephone #:

PERSONAL REFERENCES (2 of 3)

Name:

Occupation:

Address Line 1:

Address Line 2:

City:

State:

Telephone #:

PERSONAL REFERENCES (3 of 3)

Name:

Occupation:

Address Line 1:

Address Line 2:

City:

State:

Telephone #:

CONTACT INFORMATION

May we telephone you to follow up on this application at home?

YES NO

If yes, what is the best time to call?

May we telephone you to follow up this application at work?

YES NO

If yes, what is the best time to call?

What is your business telephone number?