Desired Position

Expected Salary

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date ofBirth

YYYY

Driver's License Number

Driver's Licence Expiration Date

YYYY

Contact Number(s)

Education

Please list institutions you've attended, the date you attended them, and what degree or diploma you received from the institution.

Child Care Training

Please list all courses, workshops, and conferences related to child development and early childhood education. Include the title of the workshop or course, the sponsor, the location, the date(s) and the number of hours it lasted.

Employment History

Please include who the employer was, their location, your job title, when you began and ended employment, and your reason for leaving. List in order with your most recent employment.

References

Reference 1

First Name

Last Name

Reference Address 1

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference Phone 1

(###)

###

####

Reference 2

First Name

Last Name

Reference Address 2

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference Phone 2

(###)

###

####

Reference 3

First Name

Last Name

Reference Address 3

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference Phone 3

(###)

###

####

Reference 4

First Name

Last Name

Reference Address 4

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference Phone 4

(###)

###

####

Reference 5

First Name

Last Name

Reference Address 5

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference Phone 5

(###)

###

####

Reference 6

First Name

Last Name

Reference Address 6

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference Phone 6

(###)

###

####

Criminal History Background Information Checks

In accordance with Alabama law Code of Alabama 1975, Title 38, Chapter 13, effective November 1, 2000), the criminal history background information check shall be completed on each substitute, caregiver, volunteer, and domestic worker, as well as any other person who has contact with the children or unsupervised access to the children shall be reviewed. You must complete a Mandatory Criminal History Notice Form and a Criminal History Information Consent and Release Form. The fee must be submitted with the fingerprints and the consent form. Fingerprinting cards and the form will be provided to new hires for completion. If you previously had a criminal history check done for the Department of Human Resources and the required information is on file, it is not necessary to complete another criminal history check.

Previous Criminal Charges

Are there any past or previous criminal charges against you? If yes, please explain.

Current Criminal Charges

Are there any current criminal charges against you? If yes, please give details.

Signature

By signing this form, I am affirming that the above statements I have made are true and factual to the best of my knowledge; and I am granting permission for all persons, organizations, or agencies listed above to be conducted for information regarding my background