EmailMe Form - Job Application for Amanda's Garden Childcare

Name *

First Last

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Personal Information

Phone Number *

### - ### - ####

Email *

Are you eligible to work in the United States? *

Yes

No

Unless you are in the second year of a vo-tech childcare program, you must be 18 with a minimum of a diploma/GED. Do you qualify? *

Yes

No

If no, please explain:

Minimum Qualifications

High school diploma/GED

Current physical/ability to obtain one

Ability to pass FBI/BCII background check

Please check each qualification you possess.

POSITION/AVAILABILITY:

Position Applied For? *

Are you looking for:

Part time

Full time

Either

Days Available *

Hours Available *

AM

PM

For specific Day/Hour availability, please enter information below.

What date are you available to start work? *

MM / DD / YYYY

Wage Requirement

EDUCATION:

Name and Address Of School - Degree/Diploma - Graduation Date *

Skills and Qualifications: Licenses, Skills, Training, Awards *

EMPLOYMENT HISTORY:

Present Or Last Position:

Employer: *

Address: *

Supervisor: *

Phone Number *

### - ### - ####

Position Title: *

Start Date *

MM / DD / YYYY

End Date

MM / DD / YYYY

Responsibilities: *

Salary *

Input hourly wage, if not salaried.

Reason for Leaving: *

Previous Position

Employer: *

Address: *

Supervisor: *

Phone Number *

### - ### - ####

Position Title: *

Start Date *

MM / DD / YYYY

End Date *

MM / DD / YYYY

Responsibilities: *

Salary *

Input hourly wage, if not salaried.

Reason for Leaving: *

May We Contact Your Present Employer? *

Yes

No

References:
Name/Phone/Relationship
Please include at least one work related reference. *

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

Do you agree with the terms and conditions? *

Yes, I agree.

Initial *

Date *

MM / DD / YYYY

Please click the SUBMIT button only once when application is completed. It may take a minute for your application to be processed.