• APPLICATION FOR EMPLOYMENT

  • Are you legally entitled to work in the U.S?
    • POSITION 
    • Are you able to perform the essential functions of the job you are applying for, with or without reasonable accomodation?
    • Will Accept
    • Shift
    • Date Available
       - -
      2 digit month, 2 digit day, 4 digit year
    • 6:30pAVAILABILITY (This section can be removed if you are not doing in-home services). Instructions: Please indicate below by putting an X in the columns designating the times that you are available to work. Please indicate 1 hour blocks of time at a minimum.
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    • EDUCATION AND TRAINING 
    • High School Graduate or General Education (GED) Test Passed? If no, answer next question.
    • College, Business School, Military (Most recent first)

    • Name and Location .
      From To      
      Quarterly or Semester Hours    . Other (Specify)     Graduated       
      Degree & Year        
      Major or Subject      

    • Name and Location .
      From To      
      Quarterly or Semester Hours    . Other (Specify)     Graduated       
      Degree & Year        
      Major or Subject      

    • Name and Location .
      From To      
      Quarterly or Semester Hours    . Other (Specify)     Graduated       
      Degree & Year        
      Major or Subject      

    • Name and Location .
      From To      
      Quarterly or Semester Hours    . Other (Specify)     Graduated       
      Degree & Year        
      Major or Subject      

    • Occupational License, Certificate or Registration
      Number     Where Issued    
       Expiration Date   Pick a Date  
       
      Occupational License, Certificate or Registration      
      Number    Where Issued     
      Expiration Date   Pick a Date    
         
      Languages Read, Written or Spoken Fluently Other Than English      

    • VETERAN INFORMATION(Most recent) 
    • Branch of Service Date of Entry   Pick a Date   
      Date of Discharge   Pick a Date      

    • BACKGROUND 
    • Have you ever been convicted of a crime (other than a moving violation) or served time? (If Yes, please describe. Conviction of a crime does not automatically disqualify you from employment.)
    • SPECIAL SKILLS AND ADDITIONAL CERTIFICATIONS HELD 
    • WORK EXPERIENCE (Most Recent First) (include voluntary work and military experience) 
    • Employer Telephone Number      Address
      Job Title     Number Employees Supervised    
      From (Month/Year)   Pick a Date   To (Month/Year)   Pick a Date   
      Hours Per Week            
      Supervisor      Specific Duties      
      Reason for Leaving      
      May We Contact This Employer?      

    • Employer Telephone Number       Address
      Job Title     Number Employees Supervised    
      From (Month/Year)   Pick a Date   To (Month/Year)   Pick a Date   
      Hours Per Week            
      Supervisor      Specific Duties      
      Reason for Leaving      
      May We Contact This Employer?      

    • Employer Telephone Number      Address
      Job Title     Number Employees Supervised    
      From (Month/Year)   Pick a Date   To (Month/Year)   Pick a Date   
      Hours Per Week            
      Supervisor      Specific Duties      
      Reason for Leaving      
      May We Contact This Employer?      

    • REFERENCES (Include only individuals familiar with your work capabilities. Do not include relatives) 
    • References
      Rows
    • APPLICANT'S CERTIFICATE AGREEMENT

      1. I understand that I may submit a copy of my résumé or curriculum vitae (CV) and that by submitting a copy of my résumé/CV I understand that it will be used only as supporting and additional background information. A résumé/CV is not an authorized substitute for a completed employee application.
      2. I understand that if I should choose to complete only a portion of the required employment application that the information submitted may not be enough information from which to base any determination on, and, as a result, my application may not receive full consideration for employment.
      3. I authorize the investigation of all statements contained in this application and release from all liability any persons or employers supplying such information. I also release from all liability that may result from making background investigations. 4. I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application (or any required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.
      5. I agree, if I am offered and accept a position, to conform to all existing and future workplace rules, regulations, policies, and procedures of .
      6. I understand and agree that reserves the right to change any wage and hours of work, in its sole discretion, at any time as deemed necessary.
      7. I understand the employment relationship will be At Will, meaning that either party can end the employment relationship at any time, and for any reason, or no reason with written notice.
      8. I understand that I must submit to fingerprinting/background checks, drug testing, and/or medical testing as part of the process to determine my fitness for employment and hereby agree to submit to such testing. I authorize all persons, agencies, or other entities to release any information concerning my background or test results and hereby release from all liability any persons, agencies, or other entities supplying such information. I also release from all liability that may result from making such investigations. I understand that I must participate in fingerprinting/background checks, drug testing, and/or medical testing prior to being offered and accepting a position with .
      9. I understand that any employment offer is contingent upon my providing proof of identity and eligibility to work within the United States to conform with the provisions of the Immigration Reform and Control Act of 1986.
      10. I understand that all programs developed as part of my job responsibilities and all materials that I am entitled to receiving as part of my employment are the property of and that I will not try to copy, use, publish, or replicate a program or any materials for personal use, business ventures, or with other businesses. I understand that if this occurs legal action will ensue against me for violating this term of my employment.

      I have read and reviewed the information contained in the employment application, as well as the above-mentioned statements of agreement. By signing this employment application, I certify that I understand all of the information requested and that i have provided information that is truthful, complete, and accurate.

    • Date*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Let's Put Our Kids First is an Equal Employment Opportunity employer, and we do not discriminate in our hiring or employment practices. All  qualified applicants will receive consideration without regard to race, color, creed, religion, national origin, age, disability, sex, or any other  characteristic protected by State or Federal law. 

  • FOR INTERNAL USE ONLY

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