Job Application Form

Application for Employment

Personal Information

Name

Phone

Address

Employment Request

Any Available

What type of employment is desired?

(check all that apply)

Full Time

Seasonal

Part Time

Split Shift

What age group do you prefer to work with?

(check all that apply)

Infants

3 year olds

Toddlers

4 year olds

2 year olds

School Age

Available start date

YYYY

Desired Salary ($ per hour)

USD

What is your current employment status?

Employed

Self-Employed

Unemployed

Student

Have you ever been employed by Tuckaway?

Yes

Education

Please list the schools, dates attended, subjects studied and degrees you have completed for High School, College, Professional or other.

(Please list from most recent to oldest)

In narrative form, please describe your special skills, talents, volunteer work or training that would help us evaluate your application for this position. Also please include any special studies or training you have received.

(examples include: CDA, CNA, First Aid, CPR, Lifeguard, Food Safety Certification, MAT...)

If you expect to complete an educational program in the near future, please list here and expected completion date.

Experience

(1) Employer

(1) Employer Name (Most Recent)

(1) Job Title

(1) Date Started

YYYY

(1) Date Ended

YYYY

(1) Employer Address

(1) Immediate Supervisor

(1) Employer Phone

(1) Type of Employment

Full Time

Part Time

Other

(1) Ending Salary

(per hour)

USD

(1) Hours Worked Per Week

(per hour)

(1) List your duties

(1) Reason For Leaving

(2) Employer

(2) Employer Name

(2) Job Title

(2) Date Started

YYYY

(2) Date Ended

YYYY

(2) Employer Address

(2) Immediate Supervisor

(2) Employer Phone

(2) Type of Employment

Full Time

Part Time

Other

(2) Ending Salary

(per hour)

USD

(2) Hours Worked Per Week

(per hour)

(2) List your duties

(2) Reason For Leaving

References

List names, Addresses and relationships of three (3) persons not related to you who know your qualifications:

(1) Name

(1) Address

(1) Phone

(1) Email

(1) Relationship

(2) Name

(2) Address

(2) Phone

(2) Email

(2) Relationship

(3) Name

(3) Address

(3) Phone

(3) Email

(3) Relationship

Personal Viewpoint

Please write a paragraph about why you desire a position at Tuckaway.

Additional Information

Have you ever been the subject of a founded complaint of child abuse and neglect in Virginia or any other state?

Yes

If 'Yes', list all and explain:

Have you ever been convicted or the subject of pending charges of any crime within Virginia or any other state?

Yes

If 'Yes', list all and explain:

Are you willing to drive a Tuckaway vehicle?

Yes

Have you ever been convicted of a law violation including moving traffic violations, but excluding offenses committed before your 18th birthday, which were finally adjudicated in a Juvenile Court or under a youth offender law?

Yes

If 'Yes', list all and explain:

What is your swimming ability?

Don't Swim

Beginner

Average

Expert

Attach Additional Documents

(If available, upload your cover sheet and resume by dragging them to this field)

Delete all uploads

Choose files or drag here

Signature

I hereby certify that all entries on this form are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part to any employment with Tuckaway. I understand that all information on this application is subject to verification and I consent to references and former employers and educational institutions listed being contacted regarding this application. I further authorize Tuckaway to rely upon and use as it sees fit, any information received from such contacts.
(to be completed at school)

Signature

Verification