Caregiver Application

If you are human, leave this field blank.

School-Age Care Program Employment Application

How did you hear about this job/referred by:

Are you work study qualified? (Yes or No)

Yes

Name (First Last Middle Initial - Don't use commas)

Present Address (Street, City, State, Zip)

How many years have you lived at this address?

Phone #

Cell Phone #

Date of birth (only if under 18):

Seeking:

Full Time

Part Time

Hourly Wage

Hours Per Week

Kind of Work Desired

What hours and days of the week are you available to work? Important! Please BE SPECIFIC!

Do you have any physical limitations or unusual health conditions which would affect your ability to perform duties of any particular position? If yes please explain: