PRE-EMPLOYMENT APPLICATION ----------------------------------------------------------------------------------------
Our Company is an equal opportunity employer and will consider all applications for all positions equally without regard to their race, sex, sexual orientation, age, color, religion, national origin, veteran status, or any disability as provided in the Americans with Disabilities Act.
This application will be given every consideration but its receipt does not imply that the applicant will be employed. Please answer each and every question in a complete and accurate manner as no action can be taken on this application until all questions have been answered.
PERSONAL INFORMATION: Name: Email: Present Address: Home Phone:
City State: Zip:
Are you a citizen of the U.S. or do you have the legal right to be employed in the United States? Yes No
Are you over 18 years of age? Yes No
Have you ever been convicted of any crime (excluding minor traffic violations) Including driving under the influence of alcohol or drugs? Yes No
If yes, please state the offense, disposition (NOTE: A conviction will not necessarily disqualify you from employment? Drivers License State Currently Valid? Yes No -----------------------------------------------------------------------------------------
EDUCATION:
High School: Name of School Address Did you Graduate?
Yes No GED From To Courses Studied: College: Name of School Address Did you Graduate?
Yes No From To Courses Studied:
Vocational/Trade School: Name of School Address Did you Graduate?
Yes No From To Courses Studied: List and describe any other School or Specialized Training? ----------------------------------------------------------------------------------------- EMPLOYMENT DESIRED: Position applied for: Status: Full-time Part-time Per Diem
Shift Desired: Days Evenings Nights Salary Desired: Date Available:
Have you ever applied to our company before? Yes No When: Have you ever worked for this company before? Yes No When: How did you learn about our company/or position?
SINCE OUR BUSINESS OPERATES ON A 24 HOUR A DAY 7 DAYS A WEEK BASIS please specify those days or hours you would be unable or unwilling to work? --------------------------------------------------------------------------------------
WORK HISTORY List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business reference.
Employer: Dates of Employment:
Address:
Supervisor’s Name:
Phone: Starting Salary: Ending Salary:
Job Duties:
Reason for Leaving: ___________________________________________________________ Employer: Dates of Employment:
Reason for Leaving: ___________________________________________________________
Reason for Leaving:
SUPPLEMENTAL EMPLOYEE INFORMATION If you worked in any of your previous employment under another name, please give that name(s) below:
Name Company
Are you presently employed? Yes No If yes, may we contact your present employer? Yes No
Have you ever worked in a child care facility that has during the term of your employment, had its license denied, revoked, or suspended in any state or jurisdiction, or been the subject of disciplinary action, or received a fine(s), while you were employed in this child care facility? Yes No
AFFIDAVIT
I certify that my answers to the forgoing questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application or during my interviews may be grounds for my immediate discharge.
I understand that investigate background inquiries are to be made on myself. These background inquiries can include convictions, motor vehicle, Professional Licenses, Educational and other reports. These reports will include information as to my character, work habits, performance and experience along with reasons for termination of past employment from various employers. Further, I understand that you will be requesting information from various Federal, State, and other agencies which maintain records concerning my past activities relating to my driving, criminal, civil and other experiences.
I authorize Broward Children’s Center Inc., without reservation, to contact CIC and/or any of their licensed agents, or any individual or agency it deems appropriate to investigate my employment history, character and qualifications and I give my full and complete consent to their revealing any and all information they wish as a result of this investigation. In addition, I hereby waive my right to bring any cause of action against these individuals fro defamation, invasion or privacy or any other reason because of their statements.
I also agree that, if I am employed, I will abide by the rules and regulations of the company. I understand that the taking of drug ands alcohol tests, when given pursuant to company policy, are a condition of continued employment and refusal to take such tests when asked will be grounds for my immediate termination. I further understand that no one in BCC, Inc. is authorized to enter into any written or verbal employment contracts with me for any definite period of time without the express consent of the Chief Executive Officer. I also understand that my employment is “at will” and may be terminated by myself or by the company at any time for any reason or no reason at all, with or without prior notice. In addition to any other reason, I may be terminated during my orientation period for my inability to adapt myself to the requirements and duties of my employment. Please type your name below to indicate you agree with the above statement SIGNATURE: DATE: Please check to receive our E-newsletter