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Employment Application
General Information
Date: ___________________________
Name: _______________________________________________________________________________
Address: _____________________________________________________________________________
City: ________________________ State: ________ Zip: _____________ Phone: __________________
Email Address: _________________________________________
Your hobbies and recreation: _____________________________________________________________
What prompted you to apply here: [ ]Advertisement [ ]Own Accord [ ]Referred [ ]Employee Referral
Position applied for: (Circle one) After-School Summer Both
(Circle one) School Age Group Leader Pre-K Teacher
Site Director
Date you can report for work? ____________________ Available Times/Days _____________________
Minimum acceptable salary: _____________________________________________________________
Do you have a current CPR certification? [ ] Yes [ ] No First Aide? [ ] Yes [ ] No
Bilingual? Language ____________________________________
Education Information
Name and Address of:
High School: __________________________________________________________________________
Circle last grade completed: 9 10 11 12 Graduate? [ ] Yes [ ] No
If no, do you have a GED? [ ] Yes [ ] No
If still in High School are you currently enrolled in a Child Development Class? [ ] Yes [ ] No
College: _____________________________________________________________________________
Circle last year completed: 1 2 3 4 Graduate? [ ] Yes [ ] No Major: _______________________
Are you planning to further your education? [ ] No [ ] Yes. When? ____________________________
Classes or training you are currently enrolled in or have taken related to Child Care?