...where employment is rewarding every day. Please fill out all fields of this form to initiate your request for consideration for employment. Please note that you will need to confirm that you have read the terms at the bottom before you can submit the form. We hope to see you soon. Personal Information First Name: Last Name: Address: City: State: Postal Code: Daytime Phone: Evening Phone: Mobile Phone: Are you 18 or Older? --Select One-- Yes No Gender: --Select One-- Female Male Email Address: Educational Background Highest Level of Education (Completed): --Select One-- None GED High School Diploma Trade Certification Associates Degree Bachelors Degree Masters Degree Please list post-secondary institutions that you have attended. Complete all information and press the Add button to record the information. NOTE: Information will not be added to your application if the Add button is not pressed. Institution Name: Attendance From - To: (MM/YYYY - MM/YYYY) Did you graduate from this institution?: --Select One-- Yes No Degree Type and Date:   Institution Name Attendance From - To Graduated Degree Type and Date Remove Entry Employment History List the last three employers, starting with the most current. Describe in detail your duties. Employer Name: Employer City/State: Job Title: Employment Dates: MM/YYYY - MM/YYYY Hours Per Week: Reason for Leaving: Supervisor Name and Phone Number: Job Description:   Employer Name Employer Location Job Title Employment Dates Hours per Week Reason for Leaving Supervisor Name Responsibilities Remove Entry Desired Position Preferred Center: All Centers Henrietta South Greece North Greece Farmington-Canandaigua Select a Position (availability not guaranteed): --Select One-- Assistant Teacher Head Teacher Receptionist Administrative Assistant Nurse Maintenance Staff Operations Manager Assistant Director Director Kitchen Staff Do you wish to work Part-time or Full Time --Select One-- Part-time Full-time Available Start Date: (mm/dd/yy) Have you ever worked for Care-a-lot Child Care?: --Select One-- Yes No If so, when? Were you referred to Care-a-lot Child Care?: --Select One-- Yes No If so, by whom: Currently Employed? --Select One-- Yes No Current Employer: May we contact your employer? --Select One-- Yes No Disclamer By checking the box below, I certify that all information provided on this form is accurate and true. I understand that submission of this form does not constitute a guarantee of an interview or employment by Care-a-lot Child Care, Inc. Upon receipt of this form, Care-a-lot Child Care, Inc. personnel may contact me to request an in-person followup, where I will need to provide additional information. I also understand that Care-a-lot Child Care, Inc., its representatives or affiliates WILL NEVER REQUEST PERSONAL OR CONFIDENTIAL INFORMATION OVER THE PHONE OR INTERNET, and that all information in this form will be used for the sole purpose of consideration for employment. I agree.

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