Application for Employment

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Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Mobile Phone*
Work Phone
Email*
Position(s) you are interested in:*
Are you over the age of 18?*
- Yes
- No
(positions working with children require the applicant to be at least 18 years of age)

Answering the questions below does not automatically disqualify you from employment
Have you ever been CHARGED with a crime of violence? (even if you never went to court)*
- Yes
- No
Please explain*
Have you ever been CHARGED with a crime of sexual abuse? (even if you never went to court)*
- Yes
- No
Please explain*
Have you ever been CHARGED with a felony crime? (even if you never went to court)*
- Yes
- No
Please explain*
Have you ever had a child for whom you were responsible removed from your custody?*
- Yes
- No
Please explain*
Have you or a child in your home ever received on-going protective services in your home?*
- Yes
- No
Please explain*
Have you ever been investigated by the Office of Children’s Services for suspected child abuse/neglect?*
- Yes
- No
Please explain*
Any traffic or other offenses with a fine of $250 or more?*
- Yes
- No
Please explain*
If you have answered yes to any of these questions, please provide an explanation on a separate sheet of paper. How to provide these instructions will be available at the end of this application.
Have you ever been licensed to care for adults or children by a municipal, state, federal, or other agency?*
- Yes
- No
If yes, type of license:*
Location:*
Were you ever denied a license?*
- Yes
- No
Have you ever had a license revoked?*
- Yes
- No
Some positions at Kids’ Corps require the employee to drive. Do you have a current driver’s license?*
- Yes
- No
DL #*
State*

Employment History/Whereabouts Last 5-Years
Start with your most recent history. Please DO NOT state “see resume”. This page must be complete.
Job 1
Started Date
Ended Date
Employer Name
Employer City/State
Position Held
Reason for Leaving
Job 2
Started Date
Ended Date
Employer Name
Employer City/State
Position Held
Reason for Leaving
Job 3
Started Date
Ended Date
Employer Name
Employer City/State
Position Held
Reason for Leaving
Job 4
Started Date
Ended Date
Employer Name
Employer City/State
Position Held
Reason for Leaving
Job 5
Started Date
Ended Date
Employer Name
Employer City/State
Position Held
Reason for Leaving
Please explain any breaks in employment.
Start Date
End Date
Explanation of what you were doing (i.e. in college, stayed at home to assist my mother, still finishing high school, etc.)
Location (City/State or country)
Start Date
End Date
Explanation of what you were doing (i.e. in college, stayed at home to assist my mother, still finishing high school, etc.)
Location (City/State or country)
Start Date
End Date
Explanation of what you were doing (i.e. in college, stayed at home to assist my mother, still finishing high school, etc.)
Location (City/State or country)

Other Skills and Abilities
Please list any other skills you have that may assist you in the position you are applying for (i.e. “fluent in Spanish”, “able to communicate in sign language”, “able to organize large projects”, “proficient in the use of Microsoft Excel”, “filing”, etc.)
Other Experiences
Please list any other experience you have had in related types of work (i.e. “volunteered in a pre-school summer camp”, “assisted adults with tax form preparation”, etc.)

Please use the linked form and provide them to 3 references that can complete them FULLY. The references may NOT BE RELATED to you. Please use the boxes below to list who you provided the forms to in case KCI needs to follow-up on a reference provided.

Reference Form
Reference 1 Name
First Last
Reference Type
- Personal
- Professional
- School
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Reference 2 Name
First Last
Reference Type
- Personal
- Professional
- School
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Reference 3 Name
First Last
Reference Type
- Personal
- Professional
- School
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone

Additional Documents
Drop files here or

Accepted file types: doc, docx, pdf.
Please attach a copy of your résumé and proof of education such as HS Diploma, GED, or College Transcripts.
By typing my name in the field below, I certify that the information provided in this application packet contains no willful misrepresentation or falsification and that the information given by me is true and complete to the best of my knowledge.
Electronic Signature*

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