Before and After School Employment

* denotes a mandatory field.

Personal Information

*Name:

*Street Address:

*City | State | Zip: Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory

*Home Phone:

Mobile Phone:

*Email:

Date of Birth:  (MM/DD/YY)

Employment Desires and Qualifications

*Postion Desired:
  Aide
  Group Leader
  Assistant Director
  Director

*Work Hours Available (select all that apply):
   6:15am - 9:15am
   2:45pm - 6:30pm

*Work Days Available (select all that apply):
   Monday
   Tuesday
   Wednesday
   Thursday
   Friday

*Do you have transportation to and from work each day?   Yes   No

Referred By:

High School Attended:

Years Completed:

College Attended:

College Major:

Degree Received:

Date Received:

Salary Expecations:

Certifications (i.e.: First Aid/CPR, 90-Hour Early Childhood Course, 45-Hour Infant & Toddler Course, ECE, CDA):

List all education degrees received:

With which age groups have you had experience?

What is your most enjoyable activity to share with kids?

Previous Employment

Most Recent

Employer Name:

City/State:

Phone Number:

Position Held & Salary:

Dates Worked:

Reason for Leaving:

Next Previous

Employer Name:

City/State:

Phone Number:

Position Held & Salary:

Dates Worked:

Reason for Leaving:

Next Previous

Employer Name:

City/State:

Phone Number:

Position Held & Salary:

Dates Worked:

Reason for Leaving:

Professional References

Reference 1

Name:

Relationship:

Contact Information:

Reference 2

Name:

Relationship:

Contact Information:

Reference 3

Name:

Relationship:

Contact Information:

Personal References

Reference 1

Name:

Relationship:

Contact Information:

Reference 2

Name:

Relationship:

Contact Information:

Reference 3

Name:

Relationship:

Contact Information:

Other Information

*Have you applied to Kidso, Inc. in the past?   Yes   No

*Have you ever been convicted of a crime or been found guilty in any criminal investigations or proceedings?   Yes   No

If Yes, please describe the dates, facts, and circumstances pertaining to any situations and all rehabilitation:

In conformity with applicable laws, KidsCo, Inc. is an Equal Opportunity Employer and does not discriminate on the basis of race, color, creed, religion, sex, age, marital status, national origin, or disability.