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2010 N 88th Street
(402) 496-1000
Fax: (402) 496-4209

5321 S 138th Street
(402) 895-4000
Fax: (402) 895-1607

Employment Application

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Contact Information

Are you 18 years of age or over?
Are you interested in Full Time or Part Time Hours?
Enter N/A if this does not apply to you.
Have you ever been arrested, convicted of a crime, or have a current criminal charge pending?

Education/Training

Would you be willing to continue your education by enrolling in certain courses or training programs that may be recommended?

Work Experience

May we contact?
May we contact?
May we contact:
Have you ever been discharged or requested to resign from any position?

Professional References

Personal References

PLEASE READ CAREFULLY BEFORE SIGNING

The information furnished in this application is accurate and complete, and I understand that false or misleading information may result in a refusal to hire or be cause for discharge.

In accordance with State and Federal Laws, Children’s Respite Care Center (CRCC) is required to complete a criminal background check.  I understand that my employment at CRCC is conditional upon receiving a favorable response.

I hereby authorize release of any and all information regarding my employment experience to assist in determining my suitability for employment.

Should I be employed by Children's Respite Care Center, I agree, if requested, to undergo and satisfactorily pass a medical examination prior to employment.

No written or unwritten policy or practice of CRCC creates, or is intended to create, an express or implied contract, covenant, promise, or representation between CRCC and the employee.  Employment with CRCC may be terminated at any time with or without cause or notice by either CRCC or by the employee.

Entering your name below acts as an electronic signature.