Employment Application

Employer: Apple Pie Day Care

Address: 3 South State Road

City/State/Zip: Upper Darby, Pennsylvania 19082 (610)

Telephone: 352-1064

It is the policy of Apple Pie Day Care to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.

Applicant Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Number of years at this address*

Email Address*

Daytime Phone*

Evening Phone*

Job Position Applied For:*

Salary Desired*

Have you applied to Apple Pie previously?*

Yes
No

When did you apply before? (Approximate month & year)*

Are you at least 18 years old?*

Yes
No

If you are offered employment, when would you be available to begin work?*

Are you legally eligible for employment in the United States?*

Yes
No

Have you ever been convicted of any crime, including traffic violations?*

Yes
No

Please provide details about your convinction(s)

THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.

Applicant Employment History

List your current or most recent employment first

Employer Name

Address

City/State/Zip

Job Duties

Reason for Leaving

Dates of Employment (Month/Year)

Employer Name

Address

City/State/Zip

Job Duties

Reason for Leaving

Dates of Employment (Month/Year)

Employer Name

Address

City/State/Zip

Job Duties

Reason for Leaving

Dates of Employment (Month/Year)

Applicant's Education and Training

List your education and training.

High School Name and Address*

Last Grade?*

9
10
11
12

Diploma?*

Yes
No

College Name and Address*

Did you receive a degree?*

Yes
No

If yes, degree received

Other Training (graduate, technical, vocational)

Awards, Honors, Special Achievements

Applicant's Skills

List any skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)

Applicant's Skills

Ability or Skill	Years of experience	Rate 1-5

References

List any two people who would be willing to provide a reference for you.

Name*

Address*

City/State/Zip*

Telephone*

Relationship*

Name*

Address*

City/State/Zip*

Telephone*

Relationship*

Please provide any other information that you believe should be considered

CERTIFICATION

I certify that the information provided on this Application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my Application, or if employment commences immediate termination.

I authorize Apple Pie Day Care to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

APPLICANT SIGNATURE*

Date*

Phone

This field is for validation purposes and should be left unchanged.

Employment Form