Preschool & Afterschool Child Care - Daycare Centers in Fresno Clovis & Madera

If you desire a printable form click here.
(*) Indicates a required field.

Part One: Personal Information

First Name*

Middle Name*

Last Name*

Telephone*

Street Address*

City*

State*

Zip*

Are you 18 years of age or older?* Yes No

Date of Last Physical Exam*

Date of Last TB Test*

Have you ever been employed under a different name?* Yes No

If Yes, please list all names used

Do you possess a valid California Driver's License?* Yes No

CDL Number

Has your Driver's License ever been suspended or revoked?* Yes No

If yes, please explain

First Name of Nearest Living Relative*

Last Name*

Telephone*

Relationship*

Street Address (including apt#)*

City*

State*

Zip*

Part Two: Position Applying For

Job Title*

Salary Desired*

Date Available for Employment*

Hours of Availability (use am/pm designations)*

Part Three: Previous Employment

Name of Previous_Employer (1 - most recent)*

Industry*

Telephone*

Street Address (include suite # if applicable)*

City*

State*

Zip*

Job Title*

Reason Leaving*

Date Started*

Date Ended*

Previous Employer (2)

Industry

Telephone

Street Address (include suite # if applicable)

City

State

Zip

Job Title

Reason Leaving

Date Started

Date Ended

Previous Employer (3)

Industry

Telephone

Street Address (include suite # if applicable)

City

State

Zip

Job Title

Reason Leaving

Date Started

Date Ended

Part Four: Education

Are you a High School graduate?* Yes No

If No, are you currently enrolled in the High School completion coarse? Yes No

If Yes, give expected completion date

College (1)

City/State

Major

Years Completed

Degree/Certificate or Expected Graduation Date

College (2)

City/State

Major

Years Completed

Degree/Certificate or Expected Graduation Date

College (3)

City/State

Major

Years Completed

Degree/Certificate or Expected Graduation Date

Part Five: Employment-Related Education Courses

Course Title (1)