1745 Copperhill Parkway Suite #5 
Santa Rosa, CA 95403 
707.545.2402
Extended Child Care Coalition of Sonoma County
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​STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY

PERSONNEL  RECORD
(form to be completed by employee)
​

​CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
Name of Facility
Extended Child Care
Facility Address
1745 Copperhill Parkway, Suite 5
Santa Rosa, CA 95403
Facility File Number
490107325

    PERSONAL



    PROFESSIONAL

    ​


    Previous Employment




    EDUCATION


    Employment Related Education Courses


    University, College or Business School




    REFERENCES
    (please list names of 3 persons who can give information about your background, character, abilities, etc.)




    PROFESSIONAL & TECHNICAL QUALIFICATIONS


    I hereby certify under penalty of perjury that the above statements are true and correct. I give my permission for any necessary verification.

    Extended Child Care
    Questionnaire for Prospective Employees


    RESUME
    Please upload a copy of your resume below.

    Max file size: 50MB
    Upon submission of this application, we will email you a Criminal Record Statement document and instructions. This document will be require for your application for employment to be considered complete. Thank you for your interest in working for Extended Child Care.
Submit