Employment Application Application Full Name Address City State Zip Phone Number Email Position Applying For Full TimePart Time Days & Time Available Salary Expected Do you have reliable transportation? YesNo Are you interested in bringing your children to work with you? YesNo Ages Do you have any physical condition that may restrict your performance of the job you are applying for? YesNo (Explain) Will you need any time off in the next 90 days? YesNo (Explain) Have you ever been convicted of a crime? YesNo Please be prepared to show documentation of all information you list below Education High-School DateCompleted (GED or highest grade completed if not diploma) College: Date Completed Major: Degree/Certificate Number of credit hours in early childhood development Other licenses, credentials or certificates that may qualify you Do you have an active First-Aid & CPR certification? YesNo ExpirationDate:First-Aid CPR Are you certified in Medication Administration Training (MAT)? YesNo Please list only child-related work experience in this section Business Name Phone # Job Title Age Cared For? Salary Reason For Leaving Supervisor's Name Dates Employed to Business name Phone # Job title Age Cared For? Salary Reason For Leaving Supervisor's Name Dates Employed to Non Child Care Work Business Name Phone # Job Title Salary Reason For Leaving Supervisor's Name Dates Employed to Volunteer Or Unpaid Experience Have you ever been employed at Kimbi's before? YesNo Dates Employed to What qualities about you will benefit Kimbi's? References: Two Professional references are required (Please list supervisors only, not co-workers) Employer Name Title Phone # Employer Name Title Phone # Persons to be notified in case of illness or emergency) Name Address Relationship Phone# Name Address Relationship Phone# By clicking the SUBMIT button, the applicant acknowledges all information provided to be accurate and truthful. The applicant also understands that if the information provided is found to be otherwise, the applicant shall be disqualified from consideration and or terminated from employment. Please be sure your application is complete prior to clicking the Submit button.