Heritage Baptist Child Development Center



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Heritage Baptist Child Development Center


Application For Employment

Prospective employees will receive consideration, without discrimination because of race, creed, color, sex, age, national origin, handicap or veteran status.


PERSONAL Date:

Last Name First Middle


Home Telephone





Street Address

Business Telephone


City, State, Zip


Email Address:

Have you ever applied for employment with us?

Yes No If yes: Month and Year______Location______________


Social Security #

Position desired


Pay Expected

Apart from absence for religious observance are you available for full-time work?

Yes No


Will you work overtime if asked?

Yes No


Are you legally eligible for employment in the United States?

Other special training or skills (languages, macine operations, etc.)




When will you be available to work?

Do you meet DHR Minimum Age requirement of 19 years old?

Yes No If not, when will you be 19?







EDUCATIONAL

School


Name and Location of School

Course of Study

No. of

Years


completed

Did

you graduate?



Degree or

Diploma


College












Yes


No




Business/Trade

Technical












Yes


No



High School













Yes


No



Membership in Professional or Civic Organizations


(Exclude those which may disclose your race, color, religion or national origin)




Have you ever been arrested, charged, or convicted of a criminal offense? Yes__, No__ If yes, give details. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Have you ever received treatment/counseling from a psychologist/psychiatrist/counselor? Yes__, No__ If yes, give details. _______________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________

Have you ever received treatment for drugs/alcohol abuse? Yes__, No__. If yes, give details. ______________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Have you ever been investigated for suspected child abuse/neglect? Yes__, No__. If yes, give details. ______

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________




CHILD CARE EXPERIENCE

List all courses, workshops and conferences related to child development, early childhood education, and administration/management of daycare centers. Attach additional pages if necessary.

Title of Course/Workshop Sponsor Date Location Hours





























































Write a short paragraph indicating why you applied for a position at Heritage Child Development Center, your understanding of this program, and what you think would be expected of you in this position.

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


EMPLOYMENT HISTORY List in order beginning with the most recent employment. Attach additional pages if necessary.

Employer__________________________________ Telephone________________

Address___________________________________ Employed-State month & Year

Name of Supervisor__________________________ From________ To__________

Position____________________________________ Reason for Leaving__________


Employer__________________________________ Telephone________________

Address___________________________________ Employed-State month & Year

Name of Supervisor__________________________ From________ To__________

Position____________________________________ Reason for Leaving__________

Employer__________________________________ Telephone________________

Address___________________________________ Employed-State month & Year

Name of Supervisor__________________________ From________ To__________

Position____________________________________ Reason for Leaving__________
REFERENCES Name three unrelated persons whom we may contact as references. One should be a former employer or a teacher if not previously employed.
Name____________________________________________

Address__________________________________________

Phone____________________________________________

Name ___________________________________________

Address__________________________________________

Phone____________________________________________



__________________________________________________________________________________________
Name____________________________________________

Address__________________________________________

Phone____________________________________________

We may contact the employers listed above unless you indicate those you

do not want us to contact.


Do not contact

Employer Number_____________________________ Reason______________________________________________________________________________________________



Military

Did you serve in the U.S. Armed Forces? Yes No If “Yes”, which Branch? _________________________________________________________________

Describe any training received relevant to the position for which you are applying.

The information provided in this Application for Employment is true, correct, and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal. I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.


_______________________________________________________ _____________________________________________________________



Date Signature

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