Growing Room | Employment Application

Date

Name

First Last

Address

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

Phone

Email

Date Available

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

Please list three professional references

Full Name

Position

Company

Phone

Address

Full Name

Position

Company

Phone

Address

Full Name

Position

Company

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

Date

Employment Application

Please list three professional references

Employment History

Growing Room Welaunee

Growing Room Bradfordville

Growing Room Metropolitan