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ADDRESSES OVER
THE PAST 10 YEARS (Address, City, ST, Zip)
ADDRESS 1
ADDRESS 2
ADDRESS 3
ADDRESS 4
ADDRESS 5
ADDRESS 6
ADDRESS 7
ADDRESS 8
ADDRESS 9
ADDRESS 10
EDUCATION:
Highest grade
completed 6
7
8
9
10
11
12
GED College
1
2
3
4
5
6
Have you
received any additional training, workshops, short courses, or performed
volunteer work, etc. related to the position?
Yes
No
EMPLOYMENT
HISTORY
Are you
currently or formerly employed by a sitting service (not daycare center)?
Yes
No
If so, please
list below, include name, telephone and website:
References
At least 3
references relating to childcare, Name, City, ST, Phone(s):
DO NOT use
friends or family DO NOT exclude
telephone numbers
Outline any
medical conditions you have:
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