262-564-3270
3220 30TH AVE, KENOSHA, WI 53144
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For Which Position Are You Applying?
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Date Available to Begin Work
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Full Time
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Days Available
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Tuesday
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Contact Information
Name
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First
Last
Birthdate
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Social Security Number
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Are you 16 years of age or older?
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Address
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Armed Forces Americas
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Email
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If hired, can you prove your eligibility to work in the U.S.A.?
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Have you ever been convicted of a felony?
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If yes, please explain when, where and the disposition of the case in the space below.
Add up to 5 of your most recent employers
Employment History
Company Name
Position Held
Company Location
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Alaska
American Samoa
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California
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Florida
Georgia
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Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
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Month/Year Started
Month/Year Ended
Starting Hourly Wage or Salary
Ending Hourly Wage or Salary
Supervisor Name
Reason for Leaving
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Business/Occupation
Phone
Name
First
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Business/Occupation
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Name
First
Last
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Special Skills
Certifications
Computer Skills
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Arts/Music/Drama
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High School or GED
High School Name
Address
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California
Colorado
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District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Diploma Received
Areas of Specialization / Honors
College
College Name
Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Degree Received
Areas of Specialization / Honors
Graduate School
Graduate School
Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Degree Received
Areas of Specialization / Honors
Other
Other Education
Did you gain any experience or special skills in military service which would be applicable to the position for which you are applying?
Free Response
Why are you applying for a position at Every Child's Place?
Authorization and Agreement
I authorize Every Child's Place, Inc. to check any references, except for the following:
I authorize Every Child's Place, Inc. to seek, and also authorize and request each reference and each former employer named above to give any information about me that may be sought in connection with the submission of this employment information with the following exceptions:
Every Child's Place is a drug-free work place. Applicants may be asked to complete a pre-employment drug screen.
Agreement
Check this box to agree to the following terms.
I agree (1) if employed by Every Child’s Place, Inc., that such employment may be terminated by Every Child’s Place, Inc. without liability to me for wages or salary except as may have been earned at the date of termination; (2) if employed, I grant to Every Child’s Place, Inc. and assign the right to photograph and to use my likeness for advertising of publicity purposes; (3) I agree that my employment is subject to verification that my age meets legal requirements; (4) eligible candidates are subject to a background investigation. I certify that the information given is true and correct and I understand that withholding of falsifying any information on this application is cause for immediate termination. I understand that nothing contained in this application or in the granting of an interview or position is intended to create an employment contract between the employer and myself for either employment of for providing of any benefit. I understand that I have the right to terminate my employment at any time and that Every Child’s Place, Inc. retains a similar right and that the personnel policies and/or handbooks do not constitute an employment contract. A routine inquiry may be made which will provide applicable information concerning character, general reputation, personal characteristics, and mode of living. Upon written request, additional information as to the nature and scope of the report if one is made will be provided.
Every Child's Place is an equal opportunity employer and educator. Iguaidad de opportunidades.
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