Careers For other employment opportunities please complete the Employment Application by clicking the button below. Employment Application Employment Application 4 Please complete all pages of this application even if you are submitting a Resume. Do not fill in blanks with “See Resume.” Position you are applying for: Date MM DD YYYY PERSONAL DATA Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Home Phone (###) ### #### Cell Phone (###) ### #### Email * Are you eligible for employment in the United States? Yes No Date you're available for employment: MM DD YYYY How did you hear about the job opening? Newspaper JobNet Friend TechConnect Are you a past or current Head Start parent? Yes No Are you related to a Head Start Board Member? Yes No Are you related to a current Head Start employee? Yes No If yes, please provide their name: Are you interested in: Full-Time Part-Time Full or Part-Time Program Sub Skills Do you have a drivers license? Yes No Licenses/Certifications (please list) Foreign Languages & Skill Level (please list) Computer Skills Please list which software you're skilled with. Example: Microsoft Word 2007, Excel, Publisher, etc) EDUCATION Do you have a High School Diploma or GED? Required for employment. Yes No List education i.e. Colleges, Technical College, Trades, or any other schools attended that meet the requirements of the job you are applying for. Name & Location of School (1) Course of Study Credits Earned Dates Attended Graduate Yes No Degree Attained Name & Location of School (2) Course of Study Credits Earned Dates Attended Graduate Yes No Degree Attained Name & Location of School (3) Course of Study Credits Earned Dates Attended Graduate Yes No Degree Attained WORK EXPERIENCE Name & Address of Employer (1) Supervisors Name & Phone Number May we contact this employer? Yes No Start Date MM DD YYYY End Date MM DD YYYY Wages/Beginning Wages/Ending Titles/Duties Reason for Leaving Name & Address of Employer (2) Supervisor Name & Phone May we contact this employer? Yes No Start Date MM DD YYYY End Date MM DD YYYY Wages/Beginning Wages/Ending Titles/Duties Reason for Leaving Name & Address of Employer (3) Supervisor Name & Phone May we contact this employer? Yes No Start Date MM DD YYYY End Date MM DD YYYY Wages/Beginning Wages/Ending Titles/Duties Reason for Leaving REFERENCES Name of Reference (1) Relationship Business Professional Years Acquainted Phone (###) ### #### Email Name of Reference (2) Relationship Business Personal Years Acquainted Phone (###) ### #### Email Name of Reference (3) Relationship Business Personal Years Acquainted Phone (###) ### #### Email Name of Reference (4) Relationship Business Personal Yearfs Acquainted Phone (###) ### #### Email Please include any previous experience you've had with Head Start. COMMUNITY/VOLUNTEER EXPERIENCE Name & Address of Organization (1) Contact Person Phone (###) ### #### Hours per Month Years Involved Title/Duties Performed Name & Address of Organization (2) Contact Person Phone (###) ### #### Hours per Month Years Involved Title/Duties Performed Name & Address of Organization (3) Contact Person Phone (###) ### #### Hours per Month Years Involved Title/Duties Performed Please provide any additional information you wish to share that relates to the job opening you are applying for. 1) I understand that documentation and employment eligibility for compliance with the US Immigration Control and Reform Act is required at the time of hire. 2) I understand that I am required to provide Tuberculin Test results at the time of hire. 3) I understand that enrollment in the Dept of Justice online records check is required at the time of hire and must be renewed as required by daycare licensing thereafter. 4) I hereby give my consent to Sheboygan County Head Start to contact previous employers, unless otherwise noted on the application, for purposes of verification of employment and employment references. 5) I understand that my being hired is contingent upon final approval by Head Start Policy Council. 6) I hereby certify that the facts set forth in the foregoing employment application are true and complete to the best of my knowledge. 7) I understand, if I am employed, that falsified, incomplete or misleading statements on this application will result in my dismissal. 8) I understand that due to the nature of Head Start, it is important to know that wages and hours are subject to change based on the availability of Federal and State Funding. 9) I understand that if I terminate employment within 90 days of hire I will reimburse Head Start the cost of my TB Test and Physical. This will then be deducted from my last paycheck. Electronically Sign Date MM DD YYYY Birthdate MM DD YYYY Social Security Number (Criminal Background Check will be done on Wisconsin Dept of Justice Check System) Thank you for submitting an application for employment.We will review your qualifications and contact you should your qualifications meet our job requirements.
