Job Application Question Title * 1. Date Date / Time Date Time AM/PM - AM PM OK Question Title * 2. What is your first name? OK Question Title * 3. What is your last name? OK Question Title * 4. What is your phone number? OK Question Title * 5. What is your street address? OK Question Title * 6. City & State OK Question Title * 7. At what email address would you like to be contacted? OK Question Title * 8. What location are you applying for? Marion Cedar Rapids Hiawatha School-Age Program Any of the above OK Question Title * 9. Position Applied For Before/After School Assistant Full-Time Childcare Assistant Before & After School Supervisor Part-Time Childcare Assistant Lead Teacher, 3 year old's OK Question Title * 10. Date able to start employment OK Question Title * 11. Hourly Wage Desired OK Question Title * 12. Are you at least 18 years of age Yes No OK Question Title * 13. What is the highest level of school you have completed or the highest degree you have received? Less than high school degree High school degree or equivalent (e.g., GED) Some college but no degree Associate degree Bachelor degree Graduate degree OK Question Title * 14. List Relevant Education & Training OK Question Title * 15. Previous Employment #1 Dates Employed Employers Name & Address Position Held Rate Of Pay Reason For Leaving OK Question Title * 16. Previous Employment #2 Dates Employed Employers Name & Address Position Held Rate of Pay Reason For Leaving OK Question Title * 17. Previous Employment #3 Dates Employed Employers Name & Address Position Held Rate of Pay Reason For Leaving OK Question Title * 18. May We Contact Your Previous Employers? Yes No OK Question Title * 19. Personal Reference & Phone # (3 required) OK Question Title * 20. Do you have any limitations to keep you from performing childcare duties, such as diaper changing or lifting? Yes No- If so explain Other (please specify) OK Question Title * 21. Have you ever been convicted or charged of a crime or felony? Yes No OK Question Title * 22. The State of Iowa requires mandatory background checks- Yes, I understand my employment is conditional based on a background check and I consent to a full background check,. No, I do NOT consent to a full background check. OK Question Title * 23. I (your name below) understand all questions and statements above, and declare that all answers and statements are true. False or misleading information is grounds for rejection of application or termination of employment. OK Question Title * 24. Hours Of Availability Monday Tuesday Wednesday Thursday Friday OK Question Title * 25. Upon Hiring, will you need childcare services through Hand In Hand, Inc.? Yes No OK Question Title * 26. Have you ever applied for a position with Hand In Hand, Inc.? Yes No OK DONE
