ALFAL Youth Enrichment Center

Employment Application

First Name
Last Name
Address
City
State
Zip Code
Area Code and Phone NumberForma:t 555-555-5555
Citizenship
Social Security NumberFormat 555-55-5555
Date of BirthFormat MM/DD/YYYY
E-mail Address
Position You Are Appying ForUse the arrows to locate and select the position
PREVIOUS EMPLOYMENT
CompanyCampany 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?
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?

If yes, please explain:
Have you ever been convicted of a crime?
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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