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Employment Application

Prospective Employees will receive consideration without discrimination because of race, creed, color, sex, age, national origin, handicap or veteran status

APPLICATION TO

Children's Home of Bradford (administrative/maintenance support)

Children's Center for Treament and Education

Ramsbottom Center

All for which I qualify

I Am Seeking

Date Available

Regular Employment    Summer Employment    Temporary Employment

I Am Available For

Part-Time    Full-Time        Maximum hours per week      Preferred Shift

Additional Comments

PERSONAL INFORMATION

Last Name

First Name

Middle Name

Home Street Address

City

State

Zip Code

Telephone No.

-

Best Time to Contact

A.M.    P.M.

School Phone No. (if applicable)

-

School Address (if applicable)

City

State

Zip Code

Emergency Contact (Name)

Street Address

State

Zip Code

Relationship

Emergency Telephone No.

 

 

-

 

 

I am at least 21 years old

Yes    No

Per requilation, applicants must be at least 21 old to be epmloyed in child-care at Children's Center.

Are You a U.S. citizen?

Yes    No

If hired, you must present evidence of U.S. citizenship or your legal right to live and work in this country.

Social Security No.

- -

Position Desired

How did your learn of opening?

Referred by

Have you ever been employed by this agency?

Yes    No

 

Month         Year

  

Position

Have you ever been convicted of a felony crime?

Yes    No

If hired, you will be required to submit for Child Abuse Clearence as well as a Criminal History Record Check. Certain felony crimes preclude individuals from being hired into a position with our agency.

If yes, describe in full

EDUCATION

High School

City

State

Diploma

Yes   No   G.E.D.

College

State

Degree/Major

Did you Graduate?

Yes    No

Yes    No

Yes    No

Other (Vocational)

State

Degree/Major

Did you Graduate?

Yes    No

MILITARY EXPERIENCE

Branch of Service

Highest Rank Attained

Length of Service

From  To

Speciality/Training

EXPERIENCE

Employer 1

From

To

Title

 

 

Address

City

State

Zip Code

Immediate Supervisor

Telephone No.

-

Beg. Salary  End. Salary

   

Reason for Leaving

Employer 2

From

To

Title

 

 

Address

City

State

Zip Code

Immediete Supervisor

Telephone No.

-

Beg. Salary End. Salary

 

Reason for Leaving

Employer 3

From

To

Title

 

 

Address

City

State

Zip Code

Immediate Supervisor

Telephone No.

-

Beg. Salary End. Salary

 

Reason for Leaving

Employer 4

From

To

Title