View all available positions For which position(s) are you applying? DaycareJob CoachingDirect Support ServicesCampOther Applicant Information Name (required) Address (required) City (required) State (required) ZIP (required) Phone # (required) Email Address (required) Do you have a particular person in mind to work with? YesNo If yes, Name Your Relationship to Person(s) Are you legally eligible to work in the U.S.? (required) YesNo Are you 18 years or older? (required) YesNo Do you have a health related condition that may interfere with your ability to safely and effectively perform any duties of the job for which you are applying? YesNo If yes, please explain health issue. Have you ever been known by any other name(s)? (required) YesNo If yes, indicate the name(s) Have you ever been convicted of a felony? (required) YesNo Have you ever had a founded case of child or dependent adult abuse?(required) YesNo Please list the days and times you are available to work: Monday From: To: Tuesday From: To: Wednesday From: To: Thursday From: To: Friday From: To: Saturday From: To: Sunday From: To: How many hours per week are you interested in working? (required) 1-1010-2020-3030+ Do you own a car? (required) YesNo Have you received any traffic violations within the past 3 years? (required) YesNo Are you willing to travel outside of your immediate area to provide services? YesNo Highest level of education (required) Area of study and date completed or anticipated List any other related experiences, qualifications or certifications not listed above, such as medical procedures/equipment, CPR or First Aid Certification, Mandatory Reporter Training, or languages. Employment History Begin with your most recent position. Please complete thoroughly. Employer #1 Name of Employer: Superviser's Name/Title: Employer Address: Phone #: Date Started Date Left Rate of Pay Reason for Leaving Brief Description of Job Duties Employer #2 Name of Employer: Superviser's Name/Title: Employer Address: Phone #: Date Started Date Left Rate of Pay Reason for Leaving Brief Description of Job Duties Employer #3 Name of Employer: Superviser's Name/Title: Employer Address: Phone #: Date Started Date Left Rate of Pay Reason for Leaving Brief Description of Job Duties References List the name, address, phone number, and relationship of the three references. Only one reference can be personal. The people listed as references should be able to discuss your work history, character, and ability to fulfill job responsibilities. Any delay in receiving references may result in a delay in the orientation process. Reference #1 Reference Type Professional ReferencePersonal Reference Name: Relationship: Phone: Occupation Address: City: State: ZIP: Reference #2 Reference Type Professional ReferencePersonal Reference Name: Relationship: Phone: Occupation Address: City: State: ZIP: Reference #3 Reference Type Professional ReferencePersonal Reference Name: Relationship: Phone: Occupation Address: City: State: ZIP: I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts is cause for dismissal. Which number is bigger 2 or 8?
