Head Lice Technician Application

Please complete all feilds. A resume must be attached.

PERSONAL INFORMATION

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Contact Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

YOUR INTEREST

Desired Work {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date Available to Work {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

NitPixies is open 5 days a week. Are you willing to work: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Are you over 18 years of age? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Any weekdays you are not available? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Which days? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

What hours are you available? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Do you have customer service experience? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

How many years of experience? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Do you have experience working with children? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

How many years of experience? What type of work did you do? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

What languages do you speak fluently? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

CURRENT EMPLOYMENT

Are you currently employed? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

May we contact your current employer? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

EDUCATION

School {binding ItemNumber}

Name of School {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Type of School {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Location of School {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Years in Attendance {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Degree Received {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Major {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Please list other training, certifications or licenses held: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

EMPLOYMENT

Employer {binding ItemNumber}

Employer {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Location {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Position Held {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Dates Employed {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Reason for Leaving {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

May We Contact Them? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Attach Your Resume Here {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

REFERENCES

Reference {binding ItemNumber}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Company {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Title {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Acknowledgement and Authorization

I certify that all answers given herein are true and complete to the best of my knowledge. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

I authorize investigation of all statements in this application for employment as may be necessary for an employment decision. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

I understand that false or misleading information given in my application or interview may result in discharge. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Applicant Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}