APPLICATION FOR EMPLOYMENT
The Braddock Street United Methodist Early Learning Center is an equal opportunity employer. This facility is dedicated to providing a work environment free of discrimination including, but not limited to race, color, creed, religion, age, sex, national origin, marital, or military status. The purpose of soliciting information is to assess the applicant’s abilities to perform job duties and responsibilities.
PERSONAL INFORMATION:
Full Legal Name: _________________________________ Date: ____/____/____
Social Security Number: ____-____-______ Daytime Phone: ___________________
Current Address: ________________________________________________________
City: _____________________ State: ________________ Zip Code: __________
Position Applying For: ____________________________________________________
Expected Pay Rate: $_______________ per hour
Please list hours you cannot work: _________________________________________
Age Group Preference: ___________________________________________________
EDUCATION/TRAINING HISTORY:
High School: ____________________________________________________________
Diploma/Degree Earned: ________________________
College University: _______________________________________________________
Diploma/Degree Earned: ________________________
Other Training: __________________________________________________________
_______________________________________________________________________
EMPLOYMENT HISTORY:
Dates Employed: __________________ to __________________
Employer: ______________________________________________________________
Supervisor: _________________________ Phone Number: ___________________
Position Held: _______________________
Reason for Leaving: ______________________________________________________
Dates Employed: __________________ to __________________
Employer: ______________________________________________________________
Supervisor: _________________________ Phone Number: ___________________
Position Held: _______________________
Reason for Leaving: ______________________________________________________
Dates Employed: __________________ to __________________
Employer: ______________________________________________________________
Supervisor: _________________________ Phone Number: ___________________
Position Held: _______________________
Reason for Leaving: ______________________________________________________
PERSONAL REFERENCES: (Please do not list relatives)
Name: ________________________________
Phone Number: _________________________ Relationship: _________________
Name: ________________________________
Phone Number: _________________________ Relationship: _________________
Name: ________________________________
Phone Number: _________________________ Relationship: _________________
Have you ever been convicted of any crime (misdemeanor or felony)?
Yes: _____ No: _____
If yes, please explain: ____________________________________________________
________________________________________________________________________
________________________________________________________________________
I understand that by signing this application I give my permission for the Braddock Street United Methodist Early Learning Center to check my personal references, perform state required background checks, and verify my work history with all former employers listed on this application. I also agree that said employers may release any information that is pertinent to my work history and performance.
In addition, I certify that all information contained in this application is true and correct to the best of my knowledge. I understand that falsified statements or misrepresentation of information on this application or omission of any information sought can be grounds for rejection, or if I am employed by this center, can be grounds for immediate termination from this center.
Signature: ________________________________ Date: ____/____/____