Friends of Children & Families

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Date*: Are you 18 years or older?* YesNo

Name

First: Middle: Last:

Present Address

Street*:

City*: County*: State*: Zip*:

Previous Address

Street*:

City*: County*: State*: Zip*:

Home Phone*: Mobile Phone*: Email*:

Driver’s License #*: Expiration Date*:

Referred By: If related to anyone who works for the company, please state name and relationship:

Position for which you are applying* Time to Work*: Full TimePart TimeTemporary

Are you legally authorized to work in the U.S.?*: YesNo

Are you willing to work at other locations if needed?*: YesNo

Do you have any current/projected commitments that affect your employment with the company?*: YesNo

Date you can start*: Rate of Pay desired*: Per hour*:

Any days, shifts or hours that you cannot work:

EDUCATION

High School/GED:

School and Location: # Years: Graduation: YesNo Degree/Field of Concentration:

College:

School and Location: # Years: Graduation: YesNo Degree/Field of Concentration:

Graduate:

School and Location: # Years: Graduation: YesNo Degree/Field of Concentration:

Business, Trade, or Other Training:

School and Location: # Years: Graduation: YesNo Degree/Field of Concentration:

Professional Licensure and Certification (Please list with expiration dates) e.g. CPR, first aid, early education, etc.:

Do you work or have you ever worked in the child care industry at any time? * YesNo

Do you know of any reason why you cannot perform the essential functions of the job for which you are applying with or without reasonable accommodation?*: YesNo

If yes, please explain

Do you know of any reason which would obstruct your ability to obtain employment in the child care industry or with our company specifically?*: YesNo

If yes, please explain

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?*: YesNo

If yes, please explain

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?*: YesNo

If yes, please explain

Have you ever worked in a child care facility or with a company, that has ever had a license revoked, or its license suspended in any state or has been the subject of disciplinary action, or incurred a fine during your employment?*: YesNo

If yes, please explain:

A “YES” answer to the next three questions will not necessarily preclude employment. We will consider the nature and severity of the offense, the time since the offense, the nature of the position sought, and statutory and licensing mandates.

Have you ever been convicted of, pled guilty or no contest (nolo contendre) to any crime?*: YesNo

If yes, please give details ( list all offense(s), date, place, disposition, penalty, etc.):

Have you ever been charged with any crime and had adjudication withheld, or entered a pre-trial intervention/diversion program (i.e., community service)?*: YesNo

If yes, please give details ( list all offense(s), date, place, disposition, penalty, etc.):

Please note: Florida background screening requirements will also require that as part of the hiring process you certify under oath that you have also not been arrested with disposition pending of specific crimes prohibited under the character requirements of Chapter 435, Florida Statutes, for which you have not been granted an exemption for the disqualifying offense.

Have you ever been a defendant in a civil action for an intentional tort (including but not limited to assault, battery, infliction of emotional distress, etc.)*: YesNo

If yes, please give details (case name, case number, court, date, nature of action, disposition, etc.):

PRESENT AND PREVIOUS EMPLOYMENT

From*: To*:

Name, Address and Phone # Of Employer*: Position Held, Name of Supervisor and Duties*: Ending Salary*:

Reason for Leaving*:

From: To:

Name, Address and Phone # Of Employer: Position Held, Name of Supervisor and Duties: Ending Salary:

Reason for Leaving:

From: To:

Name, Address and Phone # Of Employer: Position Held, Name of Supervisor and Duties: Ending Salary:

Reason for Leaving:

From: To:

Name, Address and Phone # Of Employer: Position Held, Name of Supervisor and Duties: Ending Salary:

Reason for Leaving:

From: To:

Name, Address and Phone # Of Employer: Position Held, Name of Supervisor and Duties: Ending Salary:

Reason for Leaving:

May we contact your present employer?* YesNo

Please give reasons for not contacting present employer:

Did you work for any employers (not just the ones listed above) under a different name? *: YesNo

If yes, which employer(s) and under what name(s):

Have you received any written reprimands, demotions, improvement plans, below satisfactory/below average performance evaluations or disciplinary suspensions during any previous employment (not just the ones listed above)? *: YesNo

If yes, please explain:

Have you ever been discharged or asked to resign from any employer (not just the ones listed above)? *: YesNo

If yes, please explain (include by whom, when and for what):

Please explain any gaps in your employment history (other than those due to personal illness, injury or disability):

REFERENCES

List below the names, address, phone number, and years acquainted of three people not related to you, whom you have known at least one year:

First Name: Last Name:

Phone: Email: Years: Acquainted

Street: City: Zip: State:

First Name: Last Name:

Phone: Email: Years: Acquainted

Street: City: Zip: State:

First Name: Last Name:

Phone: Email: Years: Acquainted

Street: City: Zip: State:

EMPLOYMENT APPLICATION CERTIFICATION

I Agree to the Employment Application Terms I consent to be contacted via text message regarding the application.

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11875 High Tech Ave # 200, Orlando, FL 32817

Phone: (407) 273-8444