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    Employment Application

    Uploaded by

    api-259190622

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Employment Application

    Uploaded by

    api-259190622
    1K views3 pages

    Original Title

    employment application

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    1K views3 pages

    Employment Application

    Uploaded by

    api-259190622

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    1

    Byrd House Beginnings LLC



    Employment Application
    Applicant Information
    Full Name: Date:
    Last First M.I.

    Address:
    Street Address Apartment/Unit #


    City State ZIP Code

    Phone: Email

    Date Available: Social Security No.: 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


    Do you have a Social Security Number?
    YES

    NO


    Have you ever been convicted of a crime or
    a felony?
    YES

    NO


    If yes, explain:

    What ages are you most
    comfortable working with?

    Tell me about any experience
    you have working with children.
    Education
    High School: Address:

    From: To: Did you graduate?
    YES

    NO
    Diploma::

    College: Address:

    From: To: Did you graduate?
    YES

    NO
    Degree:

    Other: Address:

    2
    From: To: Did you graduate?
    YES

    NO
    Degree:
    References
    Please list three professional references.
    Full Name: Relationship:
    Company: Phone:
    Address:

    Full Name: Relationship:
    Company: Phone:
    Address:

    Full Name: Relationship:
    Company: Phone:
    Address:
    Previous Employment
    Company: Phone:
    Address: Supervisor:

    Job Title: Starting Salary: $ Ending Salary: $

    Responsibilities:

    From: To: Reason for Leaving:

    May we contact your previous supervisor for a reference?
    YES

    NO




    Company: Phone:
    Address: Supervisor:

    Job Title: Starting Salary: $ Ending Salary: $

    Responsibilities:

    From: To: Reason for Leaving:

    May we contact your previous supervisor for a reference?
    YES

    NO




    Company: Phone:
    Address: Supervisor:

    3
    Job Title: Starting Salary: $ Ending Salary: $

    Responsibilities:

    From: To: Reason for Leaving:

    May we contact your previous supervisor for a reference?
    YES

    NO

    Training
    Are you willing to participate in annual training?
    YES

    NO


    Are you certified in Pediatric CPR and 1
    st
    Aid?
    YES

    NO


    Have you attended a Recognizing and Reporting Child
    Abuse and Neglect class?
    YES

    NO


    Do you have a valid food handlers card?
    YES

    NO


    Are you enrolled in the Oregon Criminal History Registry?
    YES

    NO


    If you are enrolled, what is your
    Registry Number and expiration
    date?:

    If hired, are you able to obtain the following requirements
    within the first 30 days?
    YES

    NO


    If hired, are you willing to compete a 40 hour class at home.
    On your own time?
    YES

    NO


    Disclaimer and Signature
    I certify that my answers are true and complete to the best of my knowledge and would like to be considered for a
    position at Byrd House Beginnings LLC.
    If this application leads to employment, I understand that false or misleading information in my application or
    interview may result in my release.
    Signature: Date:

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