Application for Employment at PlayDates


Personal Data


First Name        Last Name  

Street Address  

City          State     p;      Zip  

Home Phone          Alt Phone  

Email Address  

Are You at Least 18 Years Old?    Yes    No



Position & Availability

Position Applying For:    Child Care    Management    Any Available   

Availability:   Part Time    Full Time    Weekends Only    On Call   

When would you be able to Start Work?   Immediately    1-2 Weeks    More than 2 Weeks   



Employment History


Previous Employer (Beginning with most recent)

From      To          Position 

Company  

Street Address  

City          State          Zip  

Supervisor          Telephone  

Job Duties


Reason for Leaving  

May We Contact this Employer for Reference?    Yes    No   



Previous Employer

From      To          Position 

Company  

Street Address  

City          State          Zip  

Supervisor          Telephone  

Job Duties


Reason for Leaving  

May We Contact this Employer for Reference?    Yes    No   



Previous Employer

From      To          Position 

Company  

Street Address  

City          State          Zip  

Supervisor          Telephone  

Job Duties


Reason for Leaving  

May We Contact this Employer for Reference?    Yes    No   



Training & Qualifications


Do You have CPR Certification?    Yes    No

Education Level    High School or Equiv    Some College    Trade    Associates & Above

Other Training & Education


    
 
A Louisiana Licensed Type I Center