Employment Application

1
KidSPOT Clinics* This field is required.Which location are you interested in working at
Jonesboro
Trumann
Walnut Ridge
Blytheville
Marion
Jackson County
Paragould
2
Name* This field is required.Legal Name
First Name
Last Name
3
Phone Number* This field is required.Telephone number you can be reached at
Please enter a valid phone number.
4
EmailEmail address that you can be reached at
example@example.com
5
Address* This field is required.Address when you currently reside
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
6
Position Applying ForPlease specify what position you are applying for:
Lead Classroom Teacher (Bachelors Level)
Lead Classroom Teacher (Associates Degree)
Classroom Paraprofessional (CDA)
Classroom Assistant (High School Diploma)
Clinic Director (Bachelors Level)
Afterschool Classroom Assistant
Registered Nurse
LPN
Food Service Worker
Administrative Assistant
Board Certified Behavior Analyst
Speech Language Therapist
Occupational Therapist
Physical Therapist
Other
7
Available Work Hours* This field is required.What hours are you available to work
Full-Time
Part-Time
After School
Any Available Hours
Summer Only
8
Education* This field is required.Chose highest grade completed
GED
High School
Associates Degree
Bachelors Degree
Masters Degree
Other
Currently Enrolled in College
9
EducationSpecify Major, Degree Obtained, Additional Information
10
* This field is required.Have you ever applied at KidSPOT
YESNO
11
* This field is required.Has a court ever died you parental custodial or visitation as a result of child maltreatment? If yes explain:
12
* This field is required.Have you ever been convicted of a felony or misdemeanor including (sexual or child
YESNO
13
* This field is required.Do you have any relatives, or any other members of the same household as you employed by KidSPOT
YESNO
14
* This field is required.Have you ever been employed at KidSPOT
YESNO
15
Health Question* This field is required.Do you have any physical limitations which would give you problems in performing this job?
YESNO
16
Health Question* This field is required.Would you take a physical examination if required
YESNO
17
Health Question* This field is required.KidSPOT requires pre-employment drug testing. Can you pass a drug screening test
YESNO
18
ReferencesProvide three references (no family or employers)
Name of Reference
Reference Contact Number
Name of Reference
Reference Contact Number
Name of Reference
Reference Contact Number
19
Employment History* This field is required.Please attach a resume or list below all work history for the past six years. If self-employed, supply business references.
Employer
Employers Phone Number
Employment Duties
Dates of Employment
Reason For Leaving
20
Employment HistoryPlease attach a resume or list below all work history for the past six years. If self-employed, supply business references.
Employer
Employers Phone Number
Employment Duties
Dates of Employment
Reason for Leaving
21
Tell us about yourselfDescribe why you want to work at KidSPOT and why you would be a good addition to our KidSPOT Team.
22
Date* This field is required.Today's Date
Date
Year
Month
Day
23
Signature* This field is required.I certify that everything in this application is true and correct to the best of my knowledge. I understand that misleading or incorrect statements or consequential omissions may render the application void, or if employed, would be cause for termination. I authorize the individuals or institution named above to give information regarding my employment, character, and qualifications, hereby releasing them from all liability for issuing such information.
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