Kid’s Kingdom Day Care Inc.

Employment Application

KKDC is an equal opportunity employer

This application must be completed with a blue or black pen by the applicant only. Please print legibly and answer all questions.

Last Name / First Name / Middle Name / Email Address
Street Address / City, State / Zip Code / Phone Number
Date of Application / Position Desired / Date Available to Start / Expected Salary

Yes No Yes No

Are you at least 18 years old? / Have you ever applied at KKDC before?
Are you legally able to work in the U.S.? / Are you currently employed?
Are you able to perform the job you are applying for with our without accommodations? / If so, can we contact your present employer?

Education

School / Name and Location / Graduated
Yes No / Area of Study / Degree Awarded / Overall
GPA

Current and Prior Employment

Dates of Employment
(From-To) / Pay Rate or Salary / Employer Name and Address / Type of Business / Position Held / Primary Duties / Reason for Leaving

Employment or Educational References

The Following are individuals that KKDC may contact:

Name / Position and Company / Address / Phone Number

Other Information

Are you currently on the Registry? YES_____ NO_____ If yes, Registry Level______

How did you hear about this vacancy? ______

Have you ever been convicted of or pled guilty to a crime? YES_____ NO_____

If yes, please identify the crime(s) for which you were convicted or pled guilty to, the date of conviction and the state and county where you were convicted: ______

______

Are you currently out on bail, probation or subject to any parole conditions? YES_____ NO______

If yes, please explain: ______

______

Are there additional skills related to this position which you would like to share? ______

______

Please Read Carefully

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed; falsified statements on this application may be grounds for dismissal. I authorize investigation of all statements contained herein and the employers listed above to give you any and all information concerning my previous employment. I understand and agree that, if hired, my employment is for no definite period and may regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause.”

______

Signature Date

Note: This application will be retained in an active file for a period of one year.