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Country Kids Learning Center, L.L.C.

providing families with quality childcare since 1993

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EMPLOYMENT APPLICATION

Personal Information

First name*

Last name*

Birthday*

Month

Day

Year

Phone*

Address*

Email*

Social Security #*

Are you CPR Certified*

Yes

No

Highest Level of Education*

GED/ HS diploma

College Degree

Other

References

Reference #1*

Reference 1: Phone*

Connection to Reference #1*

Reference #2

Reference 2: Phone

Connection to Reference #2

Current/Prior Employment

Company name*

Position*

May we contact?*

Yes

No

Availability

Available Shifts*

6:30 a.m. - 3:30 p.m.

7:30 a.m. - 5/5:30 p.m.

9:00 a.m. - 6:00 p.m.

Part Time

Preferred Age Group*

Infants (0-12mnths)

Toddlers (12-24mnths)

Twos (24-36mnths)

Preschool (3-5yrs+)

Center Support

Disclaimer and Signature

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.

Upload Resume

Starting Availability*

Signature*

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Employment Application

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