Application for Employment

Date of Application

First Name

Last Name

Date of Birth

Phone

Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Salary Requirements ($/hr):

Have you ever been convicted of breaking a law other than a minor traffic violation?

If offered employment with Hawfields Child Care, do you agree to complete a Child Care Background Check as required by the NCDHHS Division for Child Development and Early Education?

Education

Are you currently enrolled in High School, have a High School Diploma, or GED?

Name of High School(s) and Highest Grade Completed

College or University

Course of Study

Graduate or Professional

Educational, Vocational Schools, etc.

Child Care trainings you have completed in the last three years (ex. First Aid, CPR, CDA, ITS-SIDS, etc.):

List the first & last names, email addresses, and phone numbers of two people we may contact as references for you:

Work History

(List Child Care/Early Childhood Experience First)

Current/Last Employer

Job Title

Supervisor's Name

Supervisor's Phone Number

Supervisor's Email Address

Date Employed (mo/yr)

Date Separated (mo/yr)

Duties:

Reason for Leaving

Ending Salary ($/hr)

May we contact this employer?

Current/Last Employer

Job Title

Supervisor's Name

Supervisor's Phone Number

Supervisor's Email Address

Date Employed (mo/yr)

Date Separated (mo/yr)

Reason for Leaving

Ending Salary ($/hr)

Duties:

May we contact this employer?

I certify that the information provided on this form is true, accurate, and complete to the best of my knowledge. I authorize educational institutions, professional associations, licensing and registration boards, and other relevant organizations to release any information necessary to verify my qualifications. I also authorize an investigation of all statements made in this application. I understand that providing false information or documentation, or failing to disclose relevant information, may result in the rejection of my application, disciplinary action, dismissal from employment, and/or criminal prosecution. I further understand that if I am found to have provided fraudulent information to meet position qualifications, termination of employment will be mandatory, and unemployment benefits may be denied.

Signature

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