Careers Form

Honey Bee Palace Employee Application

Last Name *

First Name *

Middle Initial *

Date of Birth *

Home Address *

City *

State *

Zip Code *

Home Phone*

Cell Number*

Email Address*

Location Applying?*

Honey Bee Palace 2

Which age group are you comfortable working with? Check all that apply:

INFANTS (ages 1 weeks to 12 months)
TODDLERS (ages 12 months to 2 ½ years)
PRE-PRESCHOOL(ages 2 ½ years to 4 years)
PRESCHOOLERS(ages 4 years to 5 years)
SCHOOLAGE(ages 6 years to 13 years)

Are you applying for *

Part Time

Full Time

Are you available for

Morning

Afternoons

Evenings

Midnight

Are you CPR certified?

Yes

No

Are First Aid Trained?

Yes

No

Are you willing to become CPR certified and First Aid Trained?

Yes

No

Are you currently Employed? If yes, Where? *

Yes

No

Please Explain

Are you at least 18 years of age? If no, How old are you? *

Yes

No

Please Explain

Do you have a high school diploma or equivalent? If yes, Which do you have? *

Yes

No

Please Explain

Do you have a college degree? If yes, Which degree *

Yes

No

Please Explain

Are you a U.S. citizen or authorized to work in the U.S.? *

Yes

No

Please Explain

Do you have any experience in child care? If yes, how long did you work in the child care field? *

Yes

No

Please Explain

Have you ever been convicted of a crime other than minor traffic offenses? If yes, explain *

Yes

No

Please Explain

Have you ever been convicted of child abuse? If yes, explain *

Yes

No

Please Explain

Have you ever been convicted of child neglect? If yes, explain *

Yes

No

Please Explain

Do you have allergies? If yes, what kind? *

Yes

No

Please Explain

Are you currently pregnant or have a disability that my affect your job performance? If yes, explain *

Yes

No

Please Explain

PREVIOUS EMPLOYMENT RECORD

Employer's Name

Address

Job Duties

Reason for Leaving

Pay Rate

Supervisor's Name

Phone

Employer's Name

Address

Job Duties

Reason for Leaving

Pay Rate

Supervisor's Name

Phone

Employer's Name

Address

Job Duties

Reason for Leaving

Pay Rate

Supervisor's Name

Phone

May we contact your present and/or past employer(s)?

Yes

No

List 3 References (not related to you)

Name

Address

Phone

Name

Address

Phone

Name

Address

Phone

What is the highest level of education you have completed?

Did you receive a Diploma?

Did you receive a Degree?

AUTHORIZATION

“I Certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal

Or otherwise, and release the company from all liability for any damage that may result from utilization of such information.”

SIGNATURE *

Date *