Employment Application

Pre-employment questionnaire. We are an equal opportunity employer.

Today's Date

PERSONAL INFORMATION

First Name

Phone

Last Name

Address:

If no, what accommodations can be made?

EMPLOYMENT DESIRED

Date you're available to start?

Our hours are 6:00 a.m. to 6:30 p.m., Monday through Friday. What days and times are you available?

List any special skills that are relevant to the position applied for:

EDUCATION

High School:

From:

College:

From:

Other:

From:

City, State:

To:

Degree:

City, State:

To:

Degree:

City, State:

To:

Degree:

EXAMPLE: ANY Early childhood, Human development, Elementary ED, CPR/AED/First Aid, etc.

Please list the courses you have taken or currently taking related to your position:

REFERENCES

Please list 3 professional references.

Name:

Company:

Phone:

Name:

Company:

Phone:

Name:

Company:

Phone:

Relationship:

Title:

Email:

Relationship:

Title:

Email:

Relationship:

Title:

Email:

EMPLOYMENT HISTORY

Please list 3 employers and ALL employment in Childcare, most recent first. Upload resume if needed.

Company:

Phone:

Address:

Position

Supervisor:

Job Responsibilities:

Starting Salary:

Ending Salary:

Reason for leaving:

Company

Phone:

Address:

Position

Supervisor:

Job Responsibilities:

Starting Salary:

Ending Salary:

Reason for leaving:

Company

Phone:

Address:

Position

Supervisor:

Job Responsibilities:

Starting Salary:

Ending Salary:

Reason for leaving:

EMPLOYMENT QUESTIONS

In your opinon, what should a school age program be like?

What activities would you plan for them?

What are your favorite ages of children you like to interact with?

If you witnessed two children fighting over a toy, how would you handle the situation?

What do you thik is appropriate discipline for school aged children?

What computer experence do you have?

Do you consider yourself a team player? If so, why?

Do you consider yourself reliable? If so, why?

APPLICATION STATEMENT

I certify that the answers and information given herein are true, correct and complete. I authorizes investigation of all statements contained in this application for employment. I understand that false or misleading information given in my application or interview(s) may result in termination regardless of when information is discovered to be false or misleading.

Your Signature

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Date:

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