EMPLOYMENT APPLICATION Net’1f S1ni Learning Cen†er TOO E 5"ᵗ Ave. Noi th Pole, Alaska 99705 907-488-7827 /0†C S•cial Security Number: ,hailing Address State: Telephone: Position Applying For: A re you 18 yeors or older? YES NO Bi r†h Day EDUCATION: Did you graduate from High School: YES NO Did you receive a G.E.D.* cocrEsE. YES NO Name and Location of School : Dates Attended: Degree Title: Major Field of Study: Other Schooling: EMPLOYMENTAPPLICACON List any relevant †i•aining o› class».s you have. Give da†e, locatlon ond the O^9^*›*'•!›•n -*ponloring the tr°•^:•s: Li»t currtn† professional licenses, cer†ifica†es or memberships in profession organizotions: This position requires 20 hours ancual training in addition to C.P.R. acd First Aide. Are you willing to participate in continuing education and training for this position7 YES NO EMPLOYMEI’4T AND EXPERIENCE: List all positions held in the last 10 years beginning with the most recent. If you provide this information ie resume format, be sure to include the information requested below. If you were not employed, list your whereabouts for the last 2 Dates Position Employer Address Describeony duties of your positions that are relevant to child care acd education, including direct caregiving, supervision of child care personnel or programs, management or administration. EMPLOYMENT APPLICATION Describe any other relevant experience or skill you have. Include volunteer work. Give details, location, supervisor, etc. REFEftENCES: List four people, including two who nre not related to you, who can comment on your character and your ability to work with children. NAME RELATIONSHIP T£LEPHON8 May we contact your present employer* YES NO Do you have any planned vacations* If yes when* We have a policy of no cell phones on your person while on duly. Emergency or needsd calsoredirec†ed†o†he Cen†er lond lne. Areyouagreeable†o†Ws? YES NO Signature of Applicant Da†e RZRBONALl Svppy Have you been preuiriusly licenced to care tor a child(reri) Have y‹au ever had n license to care for children revoked or denied in Alaeka or and other stated YES TO If 9en attach an explanation Have you ever been investigated for child ahuse or neglects YES NO U Yes, attach an explanation to yor have a ph9sicat health mental health or behavioral problem that might poee a rick to the health, safetxj or well being of children? YES NO If 9es, attach an explanation. Have 9 or been involved in a domestic violence incident within the last IO gears or do you have an alcohol or substance abuse problem that might pose a risk to the health, safety or well-being of children? YES NO If qes attach an explanation Have you been convicted of a crime or charged with a criminal offense in the last 10 years? YES i\IO It 9es, attach an explanation. Have you ever been convicted of or charge with a sex crime* I certify tr›at the contents of this form and information provided with ii are tr'ue. accurate, and complete. 1 authorize the employer to contact persons listed as references and 1understand that the employer many contact others to verify information contained here. ASH ADDITIOHA£' PAPSR IF NEEDED