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675 N Brookside Road, Wescosville, PA 18106 18106Visit us 610-481-9955 Call Us Email

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APPLICANT INFORMATION

Name *

First

Middle

Last

Email *

Phone *

Address *

Address Line 1

City

State

Zip Code

2- Column Layout

Date Available *

Position Applied for *

Desired Salary *

Are you willing to work overtime if needed? *

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Are you a citizen of the United States? *

Yes
No

If no, are you authorized to work in the U.S.? *

Yes
No

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Have you ever worked for this company? *

Yes
No

If so, when?

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Have you ever been convicted of a felony? *

Yes
No

If yes, explain

EDUCATION

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High School *

High School Address *

Address Line 1

City

State

Zip Code

From when to when

Did you graduate? *

Yes
No

Degree

College

College Address

Address Line 1

City

State

Zip Code

From when to when

Did you graduate?

Yes
No

College Degree

4-Column Layout

CPR *

Yes
No

If yes expiration date:

First Aid *

Yes
No

If yes expiration date:

Fire Safety *

Yes
No

If yes expiration date:

Criminal History / Child Abuse *

Yes
No

FBI Background check

REFERENCES

Please list three professional references.

REFERENCE 1

REFERENCE 1

Full Name *

Company *

Relationship *

Phone *

Address *

REFERENCE 2

REFERENCE 2

Full Name *

Company *

Relationship *

Phone *

Address *

REFERENCE 3

REFERENCE 3

Full Name *

Company *

Relationship *

Phone *

Address *

PREVIOUS EMPLOYMENT

Employer 1

2-Column Layout

Company *

Address *

Phone *

Supervisor *

Job Title *

Responsibilities *

Starting Salary $ *

Ending Salary $ *

From When To When *

Reason for Leaving *

May we contact your previous supervisor for a reference? *

Yes
No

Employer 2

2-Column Layout

Company *

Address *

Phone *

Supervisor *

Job Title *

Responsibilities *

Starting Salary $ *

Ending Salary $ *

From When To When *

Reason for Leaving *

May we contact your previous supervisor for a reference? *

Yes
No

Employer 3

2-Column Layout (copy)

Company *

Address *

Phone *

Supervisor *

Job Title *

Responsibilities *

Starting Salary $ *

Ending Salary $ *

From When To When *

Reason for Leaving *

May we contact your previous supervisor for a reference? *

Yes
No

MEDICAL

General Health

Allergies

Have you ever received worker's compensation?

If yes, explain.

DISCLAIMER AND SIGNATURE

DISCLAIMER *

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.

Signature *

Today's Date *

Email

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Child Today!

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A little About Us

We believe with a good start and a quality Early Education environment your child will thrive with many milestones along the way. We provide excellent child care services to Wescosville, Trexlertown, East Texas & surrounding areas.

Get in touch

675 N Brookside Road, Wescosville, PA 18106
610-481-9955

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Business Hours

Monday - Friday: 6:45 AM - 5:30 PM
Saturday & Sunday: Closed

References available upon request

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