Employment Application

Personal Information

Last Name:

First Name:

Middle Initial:

Street Address:

City:

State:

Zip Code:

Are you 18 years or older?
YesNo

Contact Information

Home Phone:

Cell Phone:

Email Address:

Employment Information

Desired Position:

Hourly Rate Desired

Are you employed now?
YesNo

Date available to begin working:

Have you previously applied at any PKA location?
YesNo

If so, when?

Which Location?

Are you a relative to any existing PKA employee?
YesNo

If yes, state their name and PKA location

Are you currently legal to work in the United States?
YesNo

Have you ever worked in a child care facility?
YesNo

Are you First Aid certified?
YesNo

State law requires that criminal history check be done on all child care personnel. Have you been convicted of any crime in the past ten years, excluding misdemeanors and summary expenses, which has not been annulled, expunged or sealed in court?
YesNo