Type of Employment Sought:    
Full-time         
Part-time         
Substitute       
Summer Only
Volunteer                                                                       
Date Available 

	                 Application For Employment

		     Carriage House Children's Center
	            The Children's Center of Pittsburgh

     Name            Cell Phone
                                       							
     Address ZipTelephone

     Person(s) to Notify in an Emergency Telephone

     Email

     EDUCATION/TRAINING (List highest level first)

     Name            Address             Major/Minor	         Degree/Diploma       Date Completed 
     
     
     

     WORK EXPERIENCE
     (Begin with the most recent and mark volunteer experience with a "V" to the left of the employer's name)

     Name of Employer        Address   	       Start/End Dates               Reason for Leaving
     
     
     
     

     The Carriage House Children's Center and its affiliates are equal opportunity employers.
 
     PROFESSIONAL REFERENCES
     (List three individuals who can attest to your qualifications for the position for which you are applying)

     Name                  Address              Telephone           Relationship
     
     
     

     SPECIAL TALENTS OR INTERESTS
     

     MEMBERSHIPS AND /OR PROFESSIONAL AFFILIATIONS
     (List those that relate to the position for which you are applying)
     

     Why are you interested in working at The Center?
     

     Have you ever been convicted of a crime, excluding misdemeanors and summary offenses?
     yes      
     no      If yes, explain: