Child Nutrition Assistant Application

	Items denoted with a red asterisk* are required.

1.	First Name*

2.	Last Name*

3.	Address*

4.	Do you have a Driver's License?*
	Yes    No

5.	Home Phone

6.	Cell or Alternate Phone*

7.	Email Address*

8.	Employment Desired?*
	Full-time Only   Part-time Only   Full - or Part-Time Employment Desired

9.	What is the highest level of education that you completed?*
	Name and Location   Graduate? - Degree?   Major/ Subjects of Study High School       College or University       GED       Specialized Training, Trade School, etc...

10.	Employment History*
	Employer Company   Position/Duties   Pay   Supervisor Name   Supervisor Phone Number   Supervisor Email   Currently Employed at Company?   Reason for Leaving?   Can we contact supervisor? Most Recent Employer                   Former Employer                   Former Employer                   Former Employer

11.	List two personal references with contact information.*
	Name   Telephone   Email   Occupation   Relationship Reference One           Reference Two

12.	List 3 Work Related References*
	Name   Telephone Number   Email Address   Occupation Reference One         Reference Two         Reference Three

13.	Please List your areas of highest proficiency, special skills or other items that may contribute to your abilities in performing the child nutrition position.*

14.	Types of computers, software, and other kitchen equipment you are qualified to operate or repair.*