Prairie Pines Childcare Center Job Application

Position Applying For: *

E-mail Address: *

First Name: *

Middle name *

Last Name: *

Address: *

City: *

State: *

Zip: *

Phone: *

Cell Number:

Best Time to Reach You: *

Morning
Afternoon
Evening

How did you learn about us?

Facebook
Word of mouth
Friend
Indeed job listing
Careers That Grow website
City of Fosston website
Other

Available Start Date: *

Highest Level of Education: *

Primary School
High School Diploma
Some College
Bachelors Degree
Graduate / Masters Degree

Previous Employer #1:

Dates Employed:

Supervisor Name

Supervisor Phone Number

Job Duties at Previous Employer:

Previous Employer #2:

Dates Employed:

Supervisor Name:

Phone Number

Job Duties at Previous Employer:

Previous Employer #3

Dates employed:

Supervisor Name

Phone Number

Job Duties at Previous Employer:

Are you at least 18 years of age? *

Yes
No

Are you currently employed? *

Yes
No

May we contact your current employer? *

Yes
No

Current employer / supervisor (name, phone, and email)

Please describe any special skills, licenses, certifications, or qualifications that are relevant to the position for which you are applying.

Reference #1 Name *

Reference #1 Phone Number *

Reference #1 Best Time to Call

Reference #2 Name

Reference #1 Occupation

Reference #2 Phone Number

Reference #2 Best Time to Call

Reference #2 Occupation

Reference #3 Name

Reference #3 Phone Number

Reference #3 Best Time to Call

Reference #3 Occupation

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 shall be grounds for dismissal. I authorize and request any and all of my former employers and any other person, firm or corporation to furnish any and all information concerning me and my personal and employment background, and I hereby release each such employer or person, firm or corporation from any and all liability by reason of furnishing the requested information. *

I understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. I agree, if employed, to devote my best efforts to the performance of my duties, to comply with all rules and regulations of the employer, and to obey all lawful directives of supervisors designated by Prairie Pines Childcare Center. *

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