<p>Type of Employment Sought: For Center Use Only: _____ Full-time Date Center _____ Part-time Received ______Substitute Interviewed ______Summer Only Started ______Volunteer Terminated ______Date Available ______</p><p>Application For Employment</p><p>Carriage House Childrens Center The Childrens Center of Pittsburgh</p><p>Name______Cell Phone______</p><p>Address______Zip______Telephone______</p><p>Person(s) to Notify in an Emergency ______Telephone______</p><p>Email ______</p><p>EDUCATION/TRAINING (List highest level first) Major/ Degree/ Date Name Address Minor Diploma Completed</p><p>______</p><p>______</p><p>______</p><p>______</p><p>WORK EXPERIENCE (Begin with the most recent and mark volunteer experience with a V to the left of the line) Start/End Reason for Name of Employer Address Dates Leaving</p><p>______</p><p>______</p><p>______</p><p>______The Carriage House Childrens Center and its affiliates are equal opportunity employers.</p><p>PROFESSIONAL REFERENCES (List three individuals who can attest to your qualifications for the position for which you are applying)</p><p>Name Address Telephone Relationship</p><p>______</p><p>______</p><p>______</p><p>______</p><p>SPECIAL TALENTS OR INTERESTS </p><p>______</p><p>______</p><p>______</p><p>______</p><p>MEMBERSHIPS AND /OR PROFESSIONAL AFFILIATIONS (List those that relate to the position for which you are applying)</p><p>______</p><p>______</p><p>Why are you interested in working at The Center? ______</p><p>______</p><p>______</p><p>Have you ever been convicted of a crime, excluding misdemeanors and summary offenses?</p><p>Yes ______No _____ If yes, explain: ______</p><p>______</p><p>Return application to: __ Carriage House Childrens Center __ The Childrens Center of Pittsburgh 5604 Solway St. 327 Craft Ave. Pittsburgh, PA 15217 Pittsburgh, PA 15213 412-421-0300 412-641-1990 412-421-3127 (Fax) [email protected]</p>