Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone (###) ### #### Have you applied before? YES NO Are you over 18? YES NO Ever convicted of a felony? YES NO Position you are applying for? Desired salary? Available start date? Days and hours of availability? Name and address of high school? Did you graduate? Did you graduate? YES NO Name and address of college/university? Number of years completed: Did you graduate? Degree earned? Name and address of current or most recent employer Job duties Job duties Salary and reason for leaving Salary and reason for leaving Name and address of next employer Job duties Salary and reason for leaving Reference #1 - Name and contact info Reference #2 - Name and contact info Why do you want to work at CLC? Why do you think you would make a good fit? Do you have any experience working with children with special needs and developmental delays? Anything else you would like to tell us? I certify that the information provided in this application is true and complete. I acknowledge that false information is grounds for not hiring me or immediate termination. I authorize the verification of any information listed. Please type your name and date. Thank you!
