EmailMe Form - Employment Application

Positions Interested In *

Before School Camp Team Member

After School Camp Team Member

Birthday Party Host/Hostess

Summer Camp Team Member

Bus Driver/Team Member

Check all positions you are interested in working.

Do you currently have a Class B Commercial Driver's License
with a Passenger Endorsement? *

Yes

No

Not required unless applying for bus driver position.

Are you a NC Licensed Teacher?

Yes

No

Do you have one of the following? *

Driver's License

Transportation to & from work for any shift you are assigned

When can you start? *

MM / DD / YYYY

Upload Your Resume
(optional)

Word or PDF Documents Only

List 3 reasons you would be a good candidate for employment at Kid's Clubhouse.

Contact Information

Name *

First MI Last

Date of Birth *

MM / DD / YYYY

Email *

Mobile Phone *

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

Home Phone

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

Social Security No. *

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Desired Hourly Wage *

Are you a citizen of the United States? *

Yes

No

If no, are you authorized to work in the U.S.?

Yes

No

Have you ever worked for Kid's Clubhouse *

Yes

No

If yes, when?

Have you ever been convicted of a felony? *

Yes

No

If yes, explain

Education

High School Attended

GED?

Did you graduate?

Yes

No

College Attended

Did you graduate?

Yes

No

Degree

Other Education

Did you graduate?

Yes

No

Degree

References

Please list three professional references.

Name of Reference #1

First Last

Company

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Relationship

Phone

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

Name of Reference #2

First Last

Company

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Relationship

Phone

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

Name of Reference #3

First Last

Company

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Relationship

Phone

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

Previous Employment

Company #1

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Job Title

Supervisor

Phone

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

Starting Salary/Wage

Ending Salary/Wage

Responsibilities

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

Company #2

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Job Title

Supervisor

Phone

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

Starting Salary/Wage

Ending Salary/Wage

Responsibilities

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

Availability

Days Available *

Hours Available for Before & After School Team Member Position

M-F 6:30am9:00am & 3:00pm-6:30pm

Hours Available for Birthday Party Host/Hostess Position

Fri. 5:30pm-9:00pm

Sat. 9:00am-9:30pm

Sun. 12:00pm-7:00pm

Hours Available for Summer Camp Team Member Position

M-F 6:30am-6:30pm

By checking the box below, I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application may result in my release. *

I understand & agree

Electronic Signature *

First MI Last

Today's Date *

MM / DD / YYYY

Kid's Clubhouse is an equal opportunity employer.