Employment Application Florida

Personal Information:

Name*

First Last

Date

Email Address*

Address*

Street Address Address Line 2 City State ZIP Code

Phone

Social Security Number

Position Applied For

Date Available

Salary Desired

Are you a citizen of the United States?

Yes
No

If no, are you authorized to work in the U.S.?

Yes
No

Have you ever worked for this company?

Yes
No

If yes, when?

Have you ever been convicted of a felony?

Yes
No

If yes, explain:

What Hours/Days are you available?

Are you willing to work overtime?*

Yes
No

Are you willing to work occational Saturdays?

Yes
No

Are you willing to attend evening/weekend staff meetings?

Yes
No

Do you have Current CPR/First Aid?

Yes
No

Are you willing to obtain and maintain current CRP/First Aid?

Yes
No

Are you willing to obtain and maintain the training required by the department of children and families and gr human resources?

Yes
No

EDUCATION:

High School/G.E.D.

Dates Attended

Diploma/Degree/Certificate

Did you graduate?

Yes
No

Address

Street Address Address Line 2 City State ZIP Code

College

Dates Attended

Diploma/Degree/Certificate

Type of Diploma or Degree received upon completion

Did you graduate?

Yes
No

Address

Street Address Address Line 2 City State ZIP Code

Other

Dates Attended

Did you graduate?

Yes
No

Diploma/Degree/Certificate

Type of Diploma or Degree received upon completion

Address

Street Address Address Line 2 City State ZIP Code

Work Experience

Most recent position first

Company Name

Supervisor

Date From

Date To

Address

Street Address Address Line 2 City State ZIP Code

Phone

Job Title

Starting Salary

Ending Salary

Responsibilities

Briefly describe your duties, responsibilities and accomplishments while employed

Reason for Leaving

May We Contact For References?

Yes
No

Company Name

Supervisor

Date From

Date To

Address

Street Address Address Line 2 City State ZIP Code

Phone

Job Title

Starting Salary

Ending Salary

Responsibilities

Briefly describe your duties, responsibilities and accomplishments while employed

Reason For Leaving

May We Contact For References?

Yes
No

Company Name

Supervisor

Date From

Date To

Address

Street Address Address Line 2 City State ZIP Code

Phone

Job Title

Starting Salary

Ending Salary

Responsibilities

Briefly describe your duties, responsibilities and accomplishments while employed

Reason for Leaving

May We Contact For References?

Yes
No

Company Name

Supervisor

Date From

Date To

Address

Street Address Address Line 2 City State ZIP Code

Phone

Job Title

Starting Salary

Ending Salary

Responsibilities

Briefly describe your duties, responsibilities and accomplishments while employed

Reason for Leaving

May We Contact For References?

Yes
No

Professional References

List at least three persons who are not related to you by blood, marriage, or adoption, to be contacted as references. At least one must be a former employer. Addresses must be complete and accurate.

Name

First Last

Relationship

Address

Street Address Address Line 2 City State ZIP Code

Phone

Company

Name

First Last

Relationship

Address

Street Address Address Line 2 City State ZIP Code

Phone

Company

Military Service

Yes
No

Branch

From

To

Section Break

Rank at Discharge

Type of Discharge

If other than honorable, explain

I certify that my answers are true and complete to the best of my know ledge. If this application leads to employment, I under stand that false or misleading information in my application or interview may result in my termination. Growing Room does not discriminate against anyone (adult or child) in any of our programs or activities based on race, color, national origin, age, disability, sex, marital status or veteran status. Our program makes accommodations as required by the ADA (Americans with Disabilities Act). We accommodate adults with special needs.

Applicant Signature*

Please use your initials as your signature

Date*

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