Employment Application - Sunflower Child Development Center

Must be 16 years of age to apply.

Date

Applicant Information

Full Name

First M.I. Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Phone

Email

Date Available

Desired hourly wage

Have you ever worked in the child care field before?

Yes
No

Have you ever been convicted of a felony?

Yes
No

Are you a citizen of the United States?

Yes
No

Are you currently undergoing any treatment for alcoholism, drug abuse, and/or child abuse?

Yes
No

I understand that upon my employment I must submit to a pre-employment physical and drug test and possible random drug testing during my employment.

Yes
No

I am free of any communicable disease or other health Concern that could pose a threat to the health, safety, And/or well-being of the children.

Yes
No

High School

Name of High School

Did you graduate?

Yes
No

College

Name of College

Did you graduate?

Yes
No

Degree

Please list three professional references.

Reference 1

Full Name

Relationship

Company

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Reference 2

Full Name

Relationship

Company

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Reference 3

Full Name

Relationship

Company

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Most Recent Employer

Company

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Supervisor

Job Title

Responsibilities

Dates

From - To

Reason for Leaving

May we contact your previous supervisor for a reference

Yes
No

Employer 2

Company

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Supervisor

Job Title

Responsibilities

Dates

From - To

Reason for Leaving

May we contact your previous supervisor for a reference

Yes
No

Branch

Dates

From - To

Rank at Discharge

Type of Discharge

If other than honorable, explain

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 or interview may result in my release.

Signature

Use your mouse, track-pad, or phone screen to sign this document above.

Date