NOW HIRING – Apply Here! | The Adventure Club

Date*

Personal Information

Name*

First Last

CURRENT Physical Address (PO Box is not a valid address):*

Street City State Zip

Is your mailing address different from your physical address?*

Yes
No

Mailing Address:*

Street City State Zip

Email*

Cell #:*

Cell Phone Provider:*

Are you of the age 18 or older?*

Yes
No

Are you a U.S. Citizen?*

Yes
No

Are you willing to provide your SS# if hired?*

Yes
No

In case of an emergency, contact:*

First Last

Relation to emergency your contact:*

Physical Address (PO Box is not a valid address):*

Street City State Zip

Cell #:*

Are you under a doctor's care?*

Yes
No

If yes, please explain:*

Are you able to lift up to 25 lbs?*

Yes
No

If no, please explain:*

Do you have any disabilities or restrictions?*

Yes
No

If yes, please explain:*

Have you lived another state other than Virginia in the past 5 years?*

Yes
No

Have you ever been convicted of a crime in Virginia or any other state?*

Yes
No

If yes, which state(s) were these crimes committed?*

If yes, please describe the crimes committed:*

Are you seeking:*

Full Time
Part Time

Our morning shifts start as early as 6am and usually end by 6pm. Please tell us what hours you're available to work Monday through Friday.

MONDAY:*

TUESDAY:*

WEDNESDAY:*

THURSDAY:*

FRIDAY:*

Requested Pay Rate:*

Do you have children that you'll need care for at Adventure Club?*

Yes
No

Educational Background

Received High School Diploma or Equivalent?*

Diploma
Equivalent
Neither

Name of High School:*

Have you earned a 2 or 4 year degree?*

2 year degree
4 year degree
Still attending
No, I have not attended college

Name of College(s) you've attended:*

Major:

Employment History

Please list previous employment, starting with most recent. If you have a resume, please attach below.

Employment Status:*

Are you currently or have you ever been legally employed?

Add Your Resume

Accepted file types: pdf, doc, docx, Max. file size: 100 MB.

Employer's Name:*

Do you currently work for this employer and if yes, may we contact them?*

Yes, I currently work for this employer, and you may contact them
Yes, I currently work for this employer, but you MAY NOT contact them
I no longer work for this employer

If we may not contact this employer, please explain why:*

Position:*

Duties:*

Start Date:*

End Date:*

Supervisor:*

Reason for Leaving:*

Additional Employer's:*

Would you like to add more fields for employment history?

Add 1 additional field
Add 2 additional fields

Employers Name:*

May we contact this employer?*

Yes
No

If No, please explain why?*

Position:*

Duties:*

Start Date:*

End Date:*

Supervisor:*

Reason for Leaving:*

Employers Name:*

May we contact this employer?*

Yes
No

If No, please explain why?*

Position:*

Duties:*

Start Date:*

End Date:*

Supervisor:*

Reason for Leaving:*

Applicant Acknowledgement*

By completing this application, you give permission for The Adventure Club to contact your references, verify your past work history, conduct a criminal background check, verify your driving record, and contact your previous employers to determine your suitability in working in the child care center.

By signing this application, you affirm that the information is true to the best of your knowledge. You also agree to release the center for any liabilities that result from the verification. Thank you.

First Last

References

Please list 3 personal referenced (not related).

Reference 1:*

First Last

Phone #:*

Reference 2:*

First Last

Phone #:*

Reference 3:*

First Last

Phone #:*

Do you have any special skills or talents that would be beneficial in working with elementary children?*

(Please include administrative, organizational and communication skills.)

What 3 words describe your personality?

(Describe their importance in a children's program.)

1:*

2:*

3:*

Describe the role that parents, children and Life Shapers play in a child care program.

Parents Role:*

Children's Role:*

Life Shaper Role:*

What do you think makes a successful before & after school program?*

As a Life Shaper, what steps would you take to: 1. Inform a parent of an accident? 2. Confront a parent of a disruptive child? 3. Respond to a parents voiced concern?*

What are your future professional goals?*

What are your future personal goals?*