Apply for Work-DalyCare

Apply for Work

DALY CARE

PLEASE FILL OUT THE FORM ONLINE AND CLICK SUBMIT. YOUR INFORMATION WILL BE AUTO-EMAILED TO US.

If you prefer, you can print out the form and fax it to us at: 412 364 2155

Last Name

First Name

Middle Initial

Address

Home Phone#

Cell Phone

Drivers License Number

State

Social Security Number

- -

Are You American Citizen

Yes No

Green Card #

Do you have a current copy of act 33

Yes No

Do you have current copy of TB test

Yes No

Do you have a current CPR card

Yes No

Date Of Hire

State Tax

Yes No

Name of State

State Unemployement

Yes No

Name of State

Occupational Tax

Yes No

Local Tax

Yes No

Name of Local

Do you have any allergies/ asthma

Yes No

if yes please list

References (Should be someone that knows your past work experience not friends or neighbors)

Name

Phone #

Name

Phone #

Do you have a current resume available?

Yes No

When could you begin to work?