Chappell Schools - THE CHAPPELL CHILD DEVELOPMENT CENTERS APPLICATION FOR EMPLOYMENT
THE CHAPPELL CHILD DEVELOPMENT CENTERS
APPLICATION FOR EMPLOYMENT
Your Name
(First, Middle Initial, Last)
Social Security Number
Date of Birth
Present Address (City, State, Zip)
Home Phone Number
Cell Number
Previous Address (City, State, Zip)
Positions Applied For
Availability:
Have you worked with Chappell before?
If yes then when? (Date)
List any Relatives or Friends Working for Chappell
Do you have your own transportation?
Have you been convicted of a crime (including sex-related or child abuse, misdemeanors & traffic offenses (for drivers)? If yes Please List the offense and Date
Do you physical limitations which might prevent you from doing certain types of work?
Have you experienced any major illnesses have you had in the past five (5) years? Please explain.
Do you Have Children?
If you answered yes to the above question please list their names and ages.
Name
Age
Name
Age
Name
Age
Name
Age
Employment History
nList every job held during the past 5 years.
Business/School
Month & Year Employed
Job Title
Name of Supervisor
May We Contact Them?
Number
Job Description
Address (City, State, Zip)
Reason for leaving
Business/School
Month & Year Employed
Job Title
Name of Supervisor
May We Contact Them?
Number
Job Description
Address (City, State, Zip)
Reason for leaving
Business/School
Month & Year Employed
Job Title
Name of Supervisor
May We Contact Them?
Number
Job Description
Address (City, State, Zip)
Reason for leaving
Business/School
Month & Year Employed
Job Title
Name of Supervisor
May We Contact Them?
Number
Job Description
Address (City, State, Zip)
Reason for leaving
Business/School
Month & Year Employed
Job Title
Name of Supervisor
May We Contact Them?
Number
Job Description
Address (City, State, Zip)
Reason for leaving
Personal References
nPlease list individuals that are not related to you.
Name
Number
Address (City, State, Zip)
Name
Number
Address (City, State, Zip)
Name
Number
Address (City, State, Zip)
Education
Name & Location
Course of Study
Degree
Name & Location
Course of Study
Degree
Only For Teacher Applicants
Please list any significant work experience and the duties performed
Please list any subjects and grades taught
What is your philosophy of teaching?
Please List One Emergency Contact
Emergency Contact
Relationship
Home Phone Number
Work Phone Number
Please read the following carefully before signing.
I declare the information provided by me in this application is true, correct and complete to the best of my knowledge. I understand that if employed, any falsification, misstatement or omission of fact on this application, regardless of when Chappell makes such a realization, may result in immediate termination of employment. I authorize the references listed above to give you any and all information concerning my previous or current employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability from any damage that may result from furnishing the same to you. I acknowledge that Chappell is a drug free/tobacco free workplace and my employment may be conditional upon successful completion of a Substance Abuse screening test as a part of Chappell's pre-employment policy. I acknowledge that if I become employed, I will be free to terminate my employment at any time for any reason and Chappell retains the same rights. No Chappell representative has the authority to make any contrary agreement.
Name
Date