Employment Application

Today's Date:


Applying for:  Full-Time Part-Time Temporary


Position Applying for:


Date available for employment:


Your Full Name:


Current Address:


City: State: Zip:


Contact & Other Information:


Home Phone:


Cell Phone:


Email:


Us CItizen:  Yes No


Do you have a Soc. Sec. Number?:  Yes No


Date of Birth:


Employment History



1) Current or Most Recent Employer :


Your Position:


How Long? From: to:


Starting Wage:


Employers Address:


Employer’s Phone:


Contact Person:


Reason for leaving or looking for other job:



2) Previous Employer :


Your Position:


How Long? From: to:


Starting Wage:


Employers Address:


Employer’s Phone:


Contact Person:


Reason for leaving or looking for other job:



3) Previous Employer :


Your Position:


How Long? From: to:


Starting Wage:


Employers Address:


Employer’s Phone:


Contact Person:


Reason for leaving or looking for other job:


Personal References (3)


(1) Name Phone:


Relationship How Long?


(2) Name Phone:


Relationship How Long?


(3) Name Phone:


Relationship How Long?


Education:


Highest Grade Level Completed:


(High School)  9 10 11 Grad GED


(College)  1 2 3 4 Degree:


Tell me about all applicable education and classes completed.



Tell me about any experience you have working with children.



What ages of children are you most comfortable working with?


Are you trained in Pediatric CPR and 1st Aid?  Yes No


Are you willing to participate in ongoing training?  Yes No


Are you currently enrolled in the Oregon Criminal History Registry?  Yes No


(note: you will not be eligible for an interview without being enrolled in the registry)
PLEASE DO NOT LINK YOURSELF TO OUR CHILD CARE.


Registry Number: Expires:


Have you ever been convicted of a crime?  Yes No


If Yes, please explain:


Are you willing to take a urinalysis for drug testing?  Yes No


Are you able to perform all the required functions of this position?  Yes No


If No, please explain :


I have answered these application questions fully and honestly and would like to be considered for a position at My Bundle of Joy. You have my permission to check all references and verify all information given here. (Please fill-in your Full Name)


Signed: Date: