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ALFAL Youth Enrichment Center
Employment Application
First Name
Last Name
Address
City
State
Zip Code
Area Code and Phone Number
Forma:t 555-555-5555
Citizenship
US Citizen
Other
Social Security Number
Format 555-55-5555
Date of Birth
Format MM/DD/YYYY
E-mail Address
Position You Are Appying For
Use the arrows to locate and select the position
Camp Counselor
PREVIOUS EMPLOYMENT
Company
Campany Name and Address
Position
How long did you work there?
# of Years, # of Months
Reason for Leaving
Have you ever held a child care license with the Department of Children and Families or been registered to provide child care in your home?
Yes
No
While employed in a child care program, have you ever been the subject of disciplinary action, or been the party responsible for a child care facility receiving an administrative fine or other disciplinary action?
Yes
No
If yes, please explain:
Have you ever been convicted of a crime?
Yes
No
If yes, please explain:
REFERENCES
Reference 1 - Name, Address, and Phone
Reference 2 - Name, Address, and Phone
Reference 3 - Name, Address, and Phone
I hereby authorize A Life For A Life International, Inc. and/or the company of its choice to conduct an independent investigation of my background, references, criminal or police records or other registries as deemed necessary or other information which may be material to my qualifications for volunteering.
I understand all information will be kept in my personal file. I certify that the information I provided in this application is true and complete to the best of my knowledge.
Signature
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ALFAL Youth Enrichment Center
ALFAL Youth Enrichment Center