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Country
Phone
Email
Date Available
MM slash DD slash YYYY
Social Security #
Desired Salary $
Position Applied For
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 this company?
Yes
No
If Yes, When?
Have you ever been convicted of a felony
Yes
No
If yes, explain
High School
Address
Dates in High School
Did you graduate?
Yes
No
College
Address
Dates in College
Did you graduate?
Yes
No
Other
Address
Dates
Did you graduate?
Yes
No
What hours/days are you available
Are you willing to work overtime?
Are you willing to work occasional saturdays?
Are you willing to attend evening/weekends staff meetings?
Do you have current CPR/First aid?
Yes
No
Are you willing to obtain and maintain the training required by the Department of Children and Families and GR Human Resources?
Yes
No
Have you completed all training required by the Department of Children and Familes to work in child care?
Yes
No
If No, please list completed courses or include transcript
Transcript, if available
Max. file size: 300 MB.
Please list three professional references
Full Name
Position
Company
Phone
Address
Full Name
Position
Company
Phone
Address
Full Name
Position
Company
Phone
Phone
Address
Employment History
Company Name
Address
Phone
Supervisor
Job Title
Responsibilities
Dates of Employment
Reason for leaving
May we contact your previous supervisor for a reference
Yes
No
Company Name
Phone
Address
Supervisor
Job Title
Responsibilities
Dates of Employment
Reason for leaving
May we contact your previous supervisor for a reference
Yes
No
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. Growing Room is an equal opportunity employer. No person shall be discriminated against due to race, religion, age, gender or disability.
Signature
(Required)
Date
MM slash DD slash YYYY
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