Cypress Preschool Employment Application
An Equal Opportunity Employer
We are an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify a representative of the organization. 
Please print and fill out all sections  (set your print margins to Left = 1.0 (all others should be 0.5))
Applicant Information
Applicant Name _____________________________________
Home Phone _______________________
Other ____________________________
Email Address ______________________________
Current Address:
Number and street _________________________________________________________
City ______________________________________
State & Zip __________________________________
How were you referred to Company?:___________________________ 
Employment Positions
Position(s) applying for:________________________________ 
Are you applying for:
•	Temporary work – such as summer or holiday work? [ ] Y or [ ] N
•	Regular part-time work? [ ] Y or [ ] N
•	Regular full-time work? [ ] Y or [ ] N 
What days and hours are you available for work?___________________________________________ 
If applying for temporary work, when will you be available? ___________________________________________ 
If hired, on what date can you start working? ___ / ___ / ___ 
Can you work on the weekends? [ ] Y or [ ] N 
Can you work evenings? [ ] Y or [ ] N 
Are you available to work overtime? [ ] Y or [ ] N 
Salary desired: $________________________________ 
Personal Information:
Have you ever applied to / worked for Company before? [ ] Y or [ ] N
If yes, please explain (include date): ________________________ 
Do you have any friends, relatives, or acquaintances working for Company? [ ] Y or [ ] N
If yes, state name & relationship: ________________________________ 
If hired, would you have transportation to/from work? [ ] Y or [ ] N 
Are you over the age of 18? (If under 18, hire is subject to verification of minimum legal age.) [ ] Y or [ ] N 
If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States? [ ] Y or [ ] N 
If hired, are you willing to submit to and pass a controlled substance test? [ ] Y or [ ] N 
Have you ever been convicted of a criminal offense (felony or misdemeanor)? [ ] Y or [ ] N 
If yes, please describe the crime - state nature of the crime(s), when and where convicted and disposition of the case.________________________________________________________________ 
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.) 
Education, Training and Experience
High School:
School name: ________________________ 
School address:________________________ 
School city, state, zip:________________________________ 
Number of years completed: _______________
Did you graduate? [ ] Y or [ ] N
Degree / diploma earned: _______________ 
College / University:
School name: __________________________ 
School address:________________________ 
School city, state, zip:________________________________ 
Number of years completed: ________
Did you graduate? [ ] Y or [ ] N
Degree / diploma earned: __________________ 
Vocational School:
Name: ________________________ 
Address:______________________ 
City, state, zip:________________________________ 
Number of years completed: ________
Did you graduate? [ ] Y or [ ] N
Degree / diploma? : __________________ 
Military:
Branch: ______________________________________
Rank in Military:________________________ 
Total Years of Service: ________
Skills/duties: ________
Related details:_________________________________
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Additional Information
Do you speak, write or understand any foreign languages? [ ] Y or [ ] N 
If yes, describe which languages(s) and how fluent of a speaker you consider yourself to be. ____________________ 
Do you have any other experience, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for working with us?
[ ] Y or [ ] N 
If yes, please explain ___________________________________________ 
Employment History
Are you currently employed? [ ] Y or [ ] N 
If you are currently employed, may we contact your current employer? [ ] Y or [ ] N 
Below, please describe past and present employment positions, dating back five years. Please account for all periods of unemployment. Even if you have attached a resume, this section must be completed. 
Name of Employer:______________________________________
Name of Supervisor:____________________________________
Telephone Number:______________________________________
Business Type:[ ________________________ 
Address:________________________ 
City, state, zip:________________________________ 
Length of Employment (Include Dates): _____________________
Position & Duties:_______________________________________________________
Reason for Leaving: _____________________________________________________________ 
May we contact this employer for references? [ ] Y or [ ] N 
Name of Employer:______________________________________
Name of Supervisor:____________________________________
Telephone Number:______________________________________
Business Type: ________________________ 
Address:________________________ 
City, state, zip:________________________________ 
Length of Employment (Include Dates): _____________________
Position & Duties:_______________________________________________________
Reason for Leaving: _____________________________________________________________ 
May we contact this employer for references? [ ] Y or [ ] N 
Name of Employer:______________________________________
Name of Supervisor:____________________________________
Telephone Number:______________________________________
Business Type: ________________________ 
Address:________________________ 
City, state, zip:________________________________ 
Length of Employment (Include Dates): _____________________
Position & Duties:_______________________________________________________
Reason for Leaving: _____________________________________________________________ 
May we contact this employer for references? [ ] Y or [ ] N 
References
List below three persons who have knowledge of your work performance within the last four years. Please include professional references only. 
Name - First, Last: ______________________________________
Telephone Number:____________________________ 
Address:________________________ 
City, state, zip:________________________________ 
Occupation: ______________________________________
Number of Years Acquainted: ______________________________________ 
Name - First, Last: ______________________________________
Telephone Number:____________________________ 
Address:________________________ 
City, state, zip:________________________________ 
Occupation: ______________________________________
Number of Years Acquainted: ______________________________________ 
Name - First, Last: ______________________________________
Telephone Number:____________________________ 
Address:________________________ 
City, state, zip:________________________________ 
Occupation: ______________________________________
Number of Years Acquainted: ______________________________________ 
Please Read and Initial Each Paragraph, then Sign Below
I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true & correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from the company. _______
I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, and by either me or the company._______
I permit the company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation._________
Applicant's Signature:______________________________           Date: ___/___/_____