HTML Preview Child Care Employee Application page number 1.
77 Scattergood Dr, Christiansburg, VA 24073 540-382-0294 www.graceachild.org
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EMPLOYEE APPLICATION
Application Date: ____________
PERSONAL INFORMATION
Name: __________________________________ Phone Number: ____________________________
Address: ____________________________________________________________________________
Email: _____________________________________________________________________________
Are you of the age 18 or older? Yes No U.S. Citizen: Yes No
Are you willing to provide your Social Security Number if hired? Yes No
In Case of Emergency, contact:
Name: ________________________________________ Relationship: ________________________
Address: ____________________________________________________________________________
Phone: ( )_______________________________ Phone ( )________________________________
Are you under a doctor’s care? Yes No If yes, explain: _______________________________
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Are you able to lift up to 25 lbs? Yes No If no, explain: _______________________________
____________________________________________________________________________________
Do you have any disabilities? Yes No If yes, explain: ________________________________
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Have you ever been convicted of a crime? Yes No If yes, explain: ______________________
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Are you presently employed? Yes No
Position applying for: ______________________________ Preferred Age Group: _________________
Group Care Experience: ________________________________________________________________
Part Time Full Time Expected Salary: _______________________________________
Hours/Days you cannot work: ___________________________________________________________
Will you have a child attending Grace-A-Child? Yes No