The Creative Play Learning Center Employment Application

Thank you for your interest in employment with The Creative Play Learning Center!

Fields in bold are required

Please use this for online submission only -- do not print and mail or fax.

Contact Information:

Last Name:
First Name:
M.I.:
Address:
City:
State:
Zip Code:
Phone Number:
Email Address:

Skills and Areas of Expertise

Do you have experiences in the following areas?: (please check all that apply):
Foreign Language
Typing
Computers
Swimming Instructor
Musical Instruments
Dance
Gymnastics

Last Physical Exam Date?:
Last TB Test?:
Do you have any weight restrictions?:
Do you have any medical conditions that limit your ability to perform the job duties within this company?:
Do you have a valid license, if so please provide license number:
Do you own your own vehicle?: yes no


Age - Please Select:

*if under 18, please state date of birth (mm/dd/yyyy):
If hired, can you provide proof that you are eligible to work in the United States?: yes no
Date you are available to start work (mm/dd/yyyy):
Are you seeking Part-Time or Full-Time Employment?: Part-Time Full-Time
Have you ever been convicted of a crime?: yes no
If yes, please explain and give dates of conviction:

Referral

How did you find out about The Creative Play Learning Center?:
(if referred or other, please specify):

Please input the jobs that you are most interested in:

First Choice:
Second Choice:
Other:

Education and Special Training

Education and Special Training:
Name of High School:
City:
State:
Degree? yes no

Special Certification(s):
College:
City:
State:
Degree? yes no
if yes, Name of Degree:

Employment History:

Starting with present or most recent, list your last two previous employers. Please include self employment, seasonal, part time jobs and volunteer work.

Employer #1 (Required)

Employer #1 Name:
Phone:
City:
State:
Employed from
to
Salary:
Supervisor:
Job Title:
Job Duties:
Reason for leaving:
May we contact?: yes no

Employer #2 (Required)

Employer #2 Name:
Phone:
City:
State:
Employed from
to
Salary:
Supervisor:
Job Title:
Job Duties:
Reason for leaving:
May we contact?: yes no

Employer #3

Employer #3 Name:
Phone:
City:
State:
Employed from
to
Salary:
Supervisor:
Job Title:
Job Duties:
Reason for leaving:
May we contact?: yes no

References:

Please provide name, address and phone # of three references not related to you and not listed above.

Reference #1:
Reference #2:
Reference #3:

Applicant's Certification & Agreement:

I voluntarily give The Creative Play Learning Center the right to make a thorough investigation of my past employment activities as well as personal history that is job related, agree to cooperate in such investigation, and release from all liability or responsibility all persons, companies, and corporations supplying such information. I agree to wear or use protective clothing, or devices as required by the company and to comply with all work and safety rules. I understand that if I accept employment at The Creative Play Learning Center can terminate my employment and can be terminated at any time, with or without cause, and that there is no contract, expressed or implied, for continued employment. I certify that the above information and information on my resume is true and accurate to the best of my knowledge, I understand that if I misrepresent or deliberately leave out a fact in my resume or application, I may be refused employment or, if I am employed, I may be terminated immediately.

Date: (mm/dd/yy) Signature: