Employment Application - Jack & Jill Center

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HomeEmployment Application

Employment Application

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Jack & Jill Children’s Center, Inc. is an equal opportunity employer and does not discriminate based on race, color, sex, religion, national origin, disability, age, marital status, political affiliation sexual orientation, pregnancy and gender expression or identity are unlawful in employment, housing, public accommodations, genetic information, veteran or military status, or any other characteristic protected by law.
Name*
First Last
Date*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State ZIP Code
Cell Phone*
Email*
Position Desired*
Date Available*
DD slash MM slash YYYY
Are you available for:*
Are you legally authorized to work in the U.S. for the position you are seeking?*
- Yes
- No
Are you 18 years of age or older?*
- Yes
- No
Do you have the ability to perform the essential functions of the job for which you are applying, with or without reasonable accommodation?*
- Yes
- No
Have you ever been known by any other names?*
- Yes
- No
If So Please List:
How were you referred to Jack & Jill Children’s Center?*
Have you ever been employed by Jack & Jill Children’s Center or have relatives who are/were employed by Jack & Jill Children’s Center?*
- Yes
- No
If so, when/who?
Level II background Screening, your completion of an Affidavit of Good Moral Character and clearance by DCF are required prior to beginning employment at Jack & Jill Children’s Center. Responding affirmatively to the information below will not disqualify you from employment.
Have you ever been convicted of a criminal offense, had adjudication withheld or pled nolo contender (no contest) to a crime?*
- Yes
- No
If yes, please explain in detail and include the date of final disposition of the case and the nature of the offense.
Have you been arrested for any crime that has not yet been adjudicated?*
- Yes
- No
If yes, please provide details regarding the arrest and include the nature of the offense..

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EDUCATION
High School or Last Grade Completed
Name of School
Address of School
Street Address City State / Province / Region ZIP / Postal Code
Course of Study
Number of Years Completed
Degree/Diploma
College or Technical School
Name of School
Address of School
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Course of Study
Number of Years Completed
Degree/Diploma
Other Schooling or Training
Name of School
Address of School
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Course of Study
Number of Years Completed
Degree/Diploma
Licenses
List all professional licenses and certifications
Have any of your licenses or certifications ever been suspended or revoked?*
- Yes
- No
If yes, please explain:
Have you ever been disciplined by any licensing authority (whether governmental or non-governmental)?*
- Yes
- No
If yes, please explain:

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Record of Employment
Describe your work experience in detail, beginning with your current or most recent job. Include military service (indicate rank) and job-related volunteer work, if applicable. Indicate number of employees supervised. Use a separate block to describe each position or gap in employment. If needed, attach additional sheets, using the same format as on the application. All information in this section must be completed.
Employer
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Position Title
Supervisor
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Begining Salary
Ending Salary
Duties
Reason for Leaving
Employer
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Position Title
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Begining Salary
Ending Salary
Duties
Reason for Leaving
Employer
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Position Title
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Begining Salary
Ending Salary
Duties
Reason for Leaving
Has any employment you have held ended involuntarily?
- Yes
- No
If yes, please explain

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Work-Related References
(Do not include relatives) Name/Occupation /Name of Business/Telephone #/Years Known
Reference One
Email
Reference Two
Email
Reference Three
Email
Reference Four
Email
Files - Please upload a cover letter, resume, salary requirements.*
Drop files here or

Accepted file types: pdf, jpg, png, doc, xls, xlsx, docx, Max. file size: 10 MB.

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(Please read this statement carefully before signing): I certify that the answers and information given by me in this application and in my submitted resume and cover letter are true and correct to the best of my knowledge and understanding. I have answered each question completely. I understand that misleading or false statements or omissions on this application or in my resume and cover letter shall be grounds for my disqualification from consideration for employment or, if employed, for dismissal from employment. I authorize investigation of all statements contained in this application and in my submitted resume and cover letter. I authorize Jack and Jill Children’s Center and/or its designees to contact the references, licensing authorities, educational institutions, and employers listed on this application and in my resume to obtain any information concerning my previous and current employment and any pertinent information that they may have about me; and I hereby release Jack and Jill Children’s Center and/or its designees and any prior and current employers or references from all liability for any damage that may result from the use of such information; and I further agree not to pursue a claim against any of them for any reason arising out of or pertaining to information as provided or used. I understand and agree that if I am hired, my employment is at will and for no definite period of time, and may be terminated by Jack and Jill Children’s Center or me at any time, with or without cause, and without any prior notice. I understand and agree that no representative of Jack and Jill Children’s Center has authority to enter into any agreement with me for employment for any specified period of time, or to waive or make any agreement to contrary to the provisions of this document, unless it is writing and signed by the Executive Director. I understand and agree that if I am hired, I must abide by the policies and procedures of Jack and Jill Children’s Center. I understand that any offer of employment is conditioned on my ability to produce the required documentation to verify my identity and U.S. citizen status or my legal right to work in the United States. I state that I have never worked at a child care facility that has, during the term of my employment (i) had its license denied, revoked, or suspended in any state or jurisdiction, or (ii) been the subject of disciplinary action, or (iii) received a fine(s), while I was employed in the child care facility. I certify and acknowledge that I have read the above statement and agree and understand it.
Signature of Applicant*
Date Signed*
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

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Many thanks to our President’s Circle,Leadership Circle, Founder’s Circle, Scholarship Circle and Champion’s Circle Corporate Partners!

Oakpoint Charitable Foundation Large

Gene And Collette Herman Family (1)

Gene And Collette Herman Family

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Halmos (1)

Holman 2

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10[1]

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Carlos & Lisa Rodriguez

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Jack & Jill Center Halmos Family Building 1315 W Broward Blvd Fort Lauderdale 33312-1664 Phone: (954) 463-8772

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