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1. Are you authorized to work in the U.S?*

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No

2. Are you willing to undergo a background check, in accordance with local law and regulations?*

Yes
No

3. Are you willing to get an employment drug screening?*

Yes
No

4. Can you reliably commute to this job location?*

Yes
No

5. Do you have the required, degree, credentials, license, diploma, or certification, for the position that you are applying for?*

Yes
No

You are not qualified to apply for this job opening

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Job Title*

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Job Location*

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HR Manager

Name*

Address*

Phone

Cell Phone

Email*

Employment Eligibility*

Are you eligible to work in the U.S.?

Yes
No

Are you at least 18 years of age?*

Yes
No

Have you ever worked in the childcare industry in the State of Florida before?*

Yes
No

Did you complete the mandatory DCF training hours?*

Yes
No

Have you ever been convicted of a crime involving child abuse or neglect?*

Yes
No

Have you ever worked in a childcare facility that has had a license denied, revoked or suspended?*

Yes
No

General Information

Have you been employed by RCMA in the past?*

Yes
No

What years?

What title?

If applying for a position that requires you to drive, are you eligible to drive a motor vehicle?*

Yes
No

Are you related by blood or marriage to anyone currently working at RCMA?*

Yes
No

Relative

Name	Relation	Office or center

Education

Select highest grade completed*

GED College/Univ*

High School

Name and location

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Date from

Hidden

Date to

Did you graduate?

Yes
No

College/University

Name and location

Date from

Date to

Did you graduate?

Yes
No

Major/Minor

College Degree Received

Graduate/Professional

Name and location

Date from

Date to

Did you graduate?

Yes
No

Major/Minor

Graduate Degree Received

Other

Name and location

Date from

Date to

Did you graduate?

Yes
No

Major/Minor

Other Degree Received

References

References*

List the names and phone numbers of three individuals who are NOT relatives or personal friends, who know about your work experience and/or education

Name	Phone number

Work History

Florida law requires that we contact all your employers for the past 5 years. List all your employers, starting with your current or most recent and going back 5 years from today.

If currently employed, may we contact your current employer?

Yes
No

1. Current or Most Recent Employer

Employer name

Address

Your Job Title

Supervisor's Name

Telephone Number

Job Duties

Date Hired

Date Terminated

Reason for Leaving

Starting Salary

$	per

Ending/Current Salary

$	per

2. Previous Employer

Name

Address

Your Job Title

Supervisor's Name

Supervisor's tel.

Employer's tel.

Job Duties

Date Hired

Date Terminated

Reason for Leaving

Starting Salary

$	per

Ending Salary

$	per

3. Previous Employer

Name

Address

Your Job Title

Supervisor's Name

Supervisor's tel.

Employer's tel.

Job Duties

Date Hired

Date Terminated

Reason for Leaving

Starting Salary

$	per

Ending Salary

$	per

4. Previous Employer

Name

Address

Your Job Title

Supervisor's Name

Supervisor's tel.

Employer's tel.

Job Duties

Date Hired

Date Terminated

Reason for Leaving

Starting Salary

$	per

Ending Salary

$	per

5. Previous Employer

Name

Address

Your Job Title

Supervisor's Name

Supervisor's tel.

Employer's tel.

Job Duties

Date Hired

Date Terminated

Reason for Leaving

Starting Salary

$	per

Ending Salary

$	per

Please explain any gaps of employment in the last 5 years:

Residency History

List all dates of residencey and the states,territories, countries you have lived in during the past 5 years:

Residency history

From	To	State

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Consent*

I certify that all answers given are true and complete to the best of my knowledge. I authorize investigation of all statements in this application for employment as necessary in making an employment decision. I understand that if selected, actual hire is contingent on clearing background screening as required by Florida law. Background screening includes character references, checking previous employers, fingerprinting, and criminal/abuse records checks. I understand that false or misleading information in my application or interview(s) may result in termination. If the job I am applying for requires me to drive for RCMA business, a motor vehicle record (MVR) will be obtained to ensure I am eligible and safe to drive. I acknowledges all above and authorizes RCMA to conduct the MVR check

I agree

RCMA considers applicants for all positions without regard to race, color, religion, sex, national origin, age, disability, marital or veteran status, or any other legally protected status. RCMA is a drug free work place. Any employee is subject to drug and alcohol testing at any time.

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Information

General Information

Education

High School

College/University

Graduate/Professional

Other

References

Work History

1. Current or Most Recent Employer

2. Previous Employer

3. Previous Employer

4. Previous Employer

5. Previous Employer

Residency History

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