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Job Application

Job Application

Please fill in as much information as possible to apply for a career at Early Childhood Alliance. Items marked with an * are required.

Step 1 of 6

16%

Enter the title(s) of the job(s) you're applying for
Personal Information
Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
Last 4 digits of your Social Security Number*
When did you move into your current address?*
Date Format: MM slash DD slash YYYY
Telephone Number*
Cell Phone Number
Email

General Information
Have you ever applied for employment with us?*
- Yes
- No
If Yes, when?*
Date Format: MM slash DD slash YYYY
Pay Expected
I am looking to work...*
- Full-Time
- Part-Time
If Part-Time, what hours would you be available to work?*
If asked, will you work over-time?*
- Yes
- No
When will you be able to begin work?*
Date Format: MM slash DD slash YYYY
Are you a U.S. citizen or alien authorized to work in this country?*
- Yes
- No
Are you 18 years of age or older?*
- Yes
- No

Employment History
Please enter employment information for Company 1
Company Name
Company Address
Street Address Address Line 2 City State ZIP Code
Company Phone
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Title
Description
Hourly Pay
Reason for leaving
Is it okay if we contact this employer?
- Yes
- No
If no, please explain
Please enter employment information for Company 2
Company Name
Company Address
Street Address Address Line 2 City State ZIP Code
Company Phone
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Title
Description
Hourly Pay
Reason for leaving
Is it okay if we contact this employer?
- Yes
- No
If no, please explain
Please enter employment information for Company 3
Company Name
Company Address
Street Address Address Line 2 City State ZIP Code
Company Phone
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Title
Description
Hourly Pay
Reason for leaving
Is it okay if we contact this employer?
- Yes
- No
If no, please explain
Please enter employment information for Company 4
Company Name
Company Address
Street Address Address Line 2 City State ZIP Code
Company Phone
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Title
Description
Hourly Pay
Reason for leaving
Is it okay if we contact this employer?
- Yes
- No
If no, please explain

Education
College Information
College Name
Location
Years Completed
Type of Degree
Major
High School Information
High School Name
Location
Years Completed
Diploma
Other Training
Provide information regarding other training you have achieved

Military Record
Branch of Service
Active From
Date Format: MM slash DD slash YYYY
Active To
Date Format: MM slash DD slash YYYY
Discharge Date
Date Format: MM slash DD slash YYYY
Duties
Training
Physical Limitations
Are there any tasks that you cannot perform due to physical limitations?*
- Yes
- No
If Yes, please explain*
Miscellaneous
Professional or Civic Organization Memberships
Please exclude those that may disclose race, religion, or national origin.
Where did you find out about this job?*
If Other, please describe*

Attachments
Attach your resume, cover letter, and/or references here
Drop files here or
Agreements
I will provide personal references upon request.*
- I agree
I hereby declare that the information provided by me in this application to be true, correct, and complete to the best of my knowledge. I understand that if employed, any misstatement or omission of fact on this application shall be considered cause for dismissal.*
- I agree
I have and understand the privacy policy.*
- Yes
Comments
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Early Childhood Alliance
3800 N Anthony Blvd, Fort Wayne, IN 46805
(800) 423-1498 | (260) 745-2501 | Food Program: (260) 333-8290 | Fax: (260) 744-3473
Office Hours: Mon-Thurs - 7:30am-5:30pm | Fri - 7:30am-11:30am

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