EMPLOYMENT APPLICATION
Kids SPOT Inc.
9461 N. 2nd Street
Roscoe, IL 61073
815.623.KIDS (5437)
www.kidsspotinc.com
TWO CHARACTER REFERENCES REQUIRED FOR EMPLOYMENT:
To be considered for hire at Kids SPOT, you are required to supply at least two references attesting to your
character and suitability for employment. References MUST be on file prior to decision to hire.
IDENTIFYING INFORMATION
NAME: Last
First
ADDRESS: Street
MI
Previous/Maiden Name
City/State
CONTACT: Primary Phone
Are you under age 18? _____
Zip
Cell/Alternate
Email Address
Work Status: Are you a US citizen? ______
Have you previously worked for Kids SPOT? _____ When? _______ Why did you leave? _______________________
Have you ever signed a non compete? ______ If so, with whom?_____________________ Date Signed__________
In the past 5 years have you been convicted of a crime (other than a traffic violation)? ______
If yes, please explain:
AVAILABILITY INFORMATION
Position(s) desired: ________________________________
Full-Time ___ Part-Time ___ Summer ____ Other ___
HOURS: Please indicate the hours you are available and willing to work each day:
Sunday
Monday
Tuesday
Can you be flexible with your schedule? ______
Wednesday
Thursday
Friday
Saturday
Date you are available to start working: ____________
At KIDS SPOT, supervising physical activities may require quick or unexpected movements
including lifting or catching (“spotting”) persons. Additional tasks may include lifting or
adjusting heavy apparatus, cleaning gym or public areas, and moving heavy boxes or equipment.
By my signature, I certify that I am able to safely perform the physical requirements listed above,
to the best of my knowledge. `
Signature _______________________________________________ Date ________
Kids SPOT Inc. Employment Application Form: 3.2009
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EMPLOYMENT APPLICATION
Kids SPOT Inc.
9461 N. 2nd Street
Roscoe, IL 61073
815.623.KIDS (5437)
www.kidsspotinc.com
EMPLOYMENT HISTORY
#1. Company Name
Address
Job Title or Position:
Phone
Describe your duties and responsibilities:
Name/Title of Immediate Supervisor
 I am no longer employed at this company.
 I am currently employed at this company; feel free to contact this person.
 I am currently employed at this company; please do NOT contact this person.
Starting wage: $__________
Final wage: $_____________
#2. Company Name
Reason for leaving: _________________________
Address
Job Title or Position:
Phone
Describe your duties and responsibilities:
Name/Title of Immediate Supervisor
 I am no longer employed at this company.
 I am currently employed at this company; feel free to contact this person.
 I am currently employed at this company; please do NOT contact this person.
Starting wage: $__________
Final wage: $_____________
#3. Company Name
Reason for leaving: _________________________
Address
Job Title or Position:
Phone
Describe your duties and responsibilities:
Name/Title of Immediate Supervisor
 I am no longer employed at this company.
 I am currently employed at this company; feel free to contact this person.
 I am currently employed at this company; please do NOT contact this person.
Starting wage: $__________
Final wage: $_____________
Kids SPOT Inc. Employment Application Form: 3.2009
Reason for leaving: _________________________
Page 2 of 4
EMPLOYMENT APPLICATION
Kids SPOT Inc.
9461 N. 2nd Street
Roscoe, IL 61073
815.623.KIDS (5437)
www.kidsspotinc.com
EDUCATIONAL INFORMATION
Name/Address of School
Graduated?
Years completed
High School
Yes _____
No _____
1
2
3
4
College
Yes _____
No _____
1
2
3
4
Other (Trade school, Training
programs, etc.)
Yes _____
No _____
1
2
3
4
Specialized Training
Post-graduate Education
Apprenticeships
Major/Course of Study
Honors/Awards
PLEASE TELL US ABOUT YOURSELF!
Kids SPOT employees are friendly, enthusiastic, and have high ethical standards. Tell us about
your ability to meet this standard, as well as any qualities you have that would positively impact
our programs, our clients, the other employees, and/or the community at large:
Kids SPOT Inc. Employment Application Form: 3.2009
Page 3 of 4
EMPLOYMENT APPLICATION
Kids SPOT Inc.
9461 N. 2nd Street
Roscoe, IL 61073
815.623.KIDS (5437)
www.kidsspotinc.com
UNDERSTANDING & AGREEMENT (please read each statement carefully)
I certify that the statements given on this application and during my interviews are true and complete, and I
authorize investigation of same (with the exception of contacting my current employer if specified).
I have read and agree to the above statement. Initial Here ________
I understand that if I am hired under any false, incomplete, or misleading information on this application or
in an interview, I may be subject to immediate termination.
I have read and agree to the above statement. Initial Here ________
I authorize the references given on this application and/or during interviews to provide any information
concerning my current/previous employment and release all parties from any liability.
I have read and agree to the above statement. Initial Here ________
I understand that, if I am hired, my continued employment is contingent upon my cooperation with training
and successful performance of duties during a new hire period of 90 days.
I have read and agree to the above statement. Initial Here ________
I understand that if I am hired my on-going employment is AT WILL, meaning employment may be
terminated by either party at any time with or without reason and with or without notice. I further
understand that this AT WILL agreement cannot be changed in any way except through a written
understanding signed by the Owners and myself.
I have read and agree to the above statement. Initial Here ________
Kids SPOT Inc. is concerned with providing a safe and secure environment for our clients. In this light, we
perform background checks on all employees, upon initial hire and upon the concern of the Owners
thereafter. I understand and agree to these background checks; I understand that my continued employment
is conditional upon the results of these checks.
Signature ______________________________________ Date _______________
TWO OR MORE CHARACTER REFERENCES ARE REQUIRED FOR EMPLOYMENT AT KIDS SPOT!
You must provide references that will attest to your suitability for employment at Kids SPOT, and they
MUST be on file before the hiring process can be completed. Instructions are provided on the reference letter
provided, and should be sent directly from the person of reference.
I have read and agree to the above statement. Initial Here ________
Kids SPOT Inc. Employment Application Form: 3.2009
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