Think 'N Play, Inc.
Employment Application
Name First:
Middle:
Last:
Address:
Email Address:
City:
State:
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AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Zip/Postal Code:
Telephone:
Previous Salary:
Desired Salary:
Minimum Salary:
In Case of Emergency:
Relationship:
Address:
Work Phone:
Home Phone:
List all organizations you belong to. (Educational & Professional):
List your hobbies and recreational activities.
What prompted you to apply here?
------
Ad
Sign
Referral
Other
If referral or other then please describe.
What position are you applying for?
When could you report for work?
Describe your formal education. (Degrees, diplomas, certification-include dates and school names):
Do you plan to continue your education?
------
Yes
No
If yes then when? where? and what field?
What special qualifications do you have?
Are you 18 years or over?
------
Yes
No
Are you 21 years or over?
------
Yes
No
Do you have a CDA?
------
Yes
No
Do you have a CDL?
------
Yes
No
Are you certified in first-aid?
------
Yes
No
Are you certified in CPR?
------
Yes
No
Are you certified in Infant CPR?
------
Yes
No
Are you a certified food handler?
------
Yes
No
Do you like to sing?
------
Yes
No
What musical instruments do you play?
What special talents do you have?
How would you describe your health?
Do you have impairments in Hearing?
Vision?
Speech?
Do you have a Previous serious illness/injury?
If so please describe:
Are there any physical or personal limitations on the type of work you can do with children or the amount of time you can spend at work?
Date of last physical exam?
PAST EMPLOYMENT
Indicate last 3 employers: dates: salaries: duties:
1.
Business Name:
Dates -- From:
To:
Address:
Telephone:
Position:
Salary:
Supervisors Name:
Duties:
Reason for leaving:
2.
Business Name:
Dates -- From:
To:
Address:
Telephone:
Position:
Salary:
Supervisors Name:
Duties:
Reason for leaving:
3.
Business Name:
Dates -- From:
To:
Address:
Telephone:
Position:
Salary:
Supervisors Name:
Duties:
Reason for leaving:
REFERENCES
Please list 3 references, not including relatives or former supervisors.
Name:
Address:
Occupation:
Telephone:
Name:
Address:
Occupation:
Telephone:
Name:
Address:
Occupation:
Telephone:
Have you ever worked in a facility that has had a license denied, revoked, or suspended in any state or jurisdiction?
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Yes
No
Have you ever been arrested?
------
Yes
No
Were you convicted?
------
Yes
No
For What?
Explain your history regarding drugs, alcohol, and smoking.
Have you ever been the subject of a disciplinary action while employed in a child care facility?
------
Yes
No
Have you ever been fined while employed in a child care facility?
------
Yes
No
I,
, attest under penalty of perjury, that the information given in this application is accurate. I also authorize a background screening, employment history check, and any other process deemed necessary to validate my ability to be employed by a child care facility.
Signature:
Date:
ADDITIONAL INFORMATION
Please, enter a code (can be text, numbers, or combination). This will be used to show that your application has been sent. It will be shown on a confirmation screen.
You can copy and paste a cover letter and resume in the spaces provided below.
Cover Letter:
Resume:
If you have a problem with the application please let us know by sending an email to
Betty Wright
.
