LASER Job Application Form

LASER Childcare is an equal opportunity employer. Please complete the form to apply for a position with us. Your application will remain on file for 30 days.
Name *

First Name Middle Initial Last Name
Which position are you applying for? *
How did you hear about LASER? *
Email Address *
Phone Number *

Area Code Phone Number
Current Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Are you at least 18 years of age? *

Yes No
Are you legally authorized to work in the U.S.? *

Yes No
Date you are able to start work:

Month Day Year
May we contact your current employer? *

Yes No
Are you on layoff status or subject to recall elsewhere? *

Yes No
Are you willing and available to work? *

Days Overtime Evenings Weekends On Call Nights Holidays
If chosen as a qualified candidate, do you consent to complete a background check? *

Yes No
Have you ever been fired or asked to resign? *

Yes No
If so, explain:
If you replied No, please type N/A.
Do you smoke? *

Yes No
Have you previously applied with us? *

Yes No
If so, when:
If you replied No, please type N/A.
Have you previously worked with us? *

Yes No
If so, when:
If you replied No, please type N/A.
Are any of your records under a different name? *

Yes No
If so, what name:
If you replied No, please type N/A.
Do you have any relatives working for us? *

Yes No
If so, who:
If you replied No, please type N/A.
Is there any reason you might be unable to meet our attendance requirements? *

Yes No
If yes, please explain:
If you replied No, please type N/A.
EDUCATION/TRAINING
High School
Name and Location *
Did you graduate? *

Yes No
College
Name and Location
Did you graduate?

Yes No In Process
Subjects Studied
College (Master's Degree)
Name and Location
Did you graduate?

Yes No In Process
Subjects Studied
Other Training (Particularly that led to license or certification)
Name and Location
Did you graduate?

Yes No In Process
Subjects Studied
Are you taking or do you plan to take any additional education? If so, what?
SKILLS/ABILITIES
List any software or machines you are skilled in using:
List any skills or abilities you have which are pertinent to the position, including hobbies or related interests:
JOB REQUIREMENTS
Will you be able to perform the essentialfunctions of the job, with or without reasonable accommodation? *

Yes No
PLEASE LIST WORK EXPERIENCE, STARTING WITH YOUR MOST RECENT POSITION, INCLUDING MILITARY AND VOLUNTEER EXPERIENCE.
Present or Last Employer:
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Start Date

Month Day Year
Date
End Date

Month Day Year
Date
Supervisor
Job Title and Duties
Reason for Leaving
Previous Employer:
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Start Date

Month Day Year
Date
End Date

Month Day Year
Date
Supervisor
Job Title and Duties
Previous Employer:
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Start Date

Month Day Year
Date
End Date

Month Day Year
Date
Supervisor
Job Title and Duties
Reason for Leaving
PROFESSIONAL REFERENCE

(Supervisors, Colleagues, Professors)
Reference #1
Name *
Phone Number *

Area Code Phone Number
Organization and Address *
Email *
example@example.com
Occupation *
How Long Known *
Reference #2
Name *
Phone Number *

Area Code Phone Number
Organization and Address *
Email *
example@example.com
Occupation *
How Long Known *
Reference #3
Name *
Phone Number *

Area Code Phone Number
Organization and Address *
Email *
example@example.com
Occupation *
How Long Known *
PLEASE READ AND AGREE TO EACH OF THE FOLLOWING ITEMS BEFORE SUBMITTING THIS APPLICATION.
1. As a final step in the hiring process, an applicant may be subject to an employment entrance exam that may include screening for illegal drugs. Applicants who confirm positive on drug screening will not be considered for employment. If a job offer is made, it may be made contingent upon the successful passing of a physical.
*

Yes
2. I CERTIFY that the facts contained in this application are true and complete, and understand that if employed, false, misleading or incomplete statements on this application shall be grounds for immediate dismissal.
*

Yes
3. I AUTHORIZE the company to investigate and verify any information contained in my application or pre-hire interviews, including my previous employment, education and background. I further release all parties from all liability for any damage that may result from furnishing or receiving such information.
*

Yes
4. I UNDERSTAND and agree that my employment and compensation may be terminated at any time without prior notice, with or without reason, at the option of the company or myself, and understand that no representative of the company, other than the Executive Director, has authority to enter into any agreement contrary to the foregoing.
*

Yes
Upload Resume *
Upload Cover Letter *
Should be Empty:

High School

Other Training (Particularly that led to license or certification)