Employment Application - Day Care Centers Inc

EDUCATION

Name of High School *

City/State

Did you graduate?

Yes

No

Name of College/University

City/State

Year of Study

Did you graduate?

Yes

No

Course of Study

Other Special Training

Include name of school, courses and dates entered/completed.

Please check all ages groups you would like to interact with (check all that apply)

Infant

Toddler

Preschoolers

School-Agers

CHARACTER REFERENCES

(do not include previous employers or relatives)

Reference #1

Name

Phone

Occupation

Reference #2

Name

Phone

Occupation

Reference #3

Name

Phone

Occupation

WORK EXPERIENCE

(List all jobs held - beginning with last employer)

Employer #1

From/To *

Company *

Address

Country

City

State

Zip code

Phone *

Supervisor *

Pay Rate *

Reason for Leaving *

Employer #2

From/To

Company

Address

Country

City

State

Zip code

Phone

Supervisor

Pay Rate

Reason for Leaving

Employer #3

From/To

Company

Address

Country

City

State

Zip code

Phone

Supervisor

Pay Rate

Reason for Leaving

ESSENTIAL FUNCTIONS

Please answer yes or no to the following questions

Any difficulty standing on feet all day?

Yes

No

Able to lift 40 lbs from floor to wait 10-15 times?

Yes

No

Able to reach child 20-30 feet away within 15 seconds without danger?

Yes

No

Able to crouch to child's eye level, sit on floor and stand?

Yes

No

Able to handle stress, tension and exasperation that many children bring every day?

Yes

No

Able to observe, see, hear and respond to children's needs and emergencies and conflict that might occur in classrooms, on playgrounds or in bathrooms and common areas?

Yes

No

Communicate effectively in the English language (verbal and written)

Yes

No

Ability to communicate with other staff members in a professional manner to form a cohesive team working towards achieving the facilities goals.

Yes

No

Have you ever been convicted of a crime, including misdemeanors, other traffic violations? *

If YES, describe in full detail.

AGREEMENT

I understand and agree that any misrepresentation by me on this application will be sufficient cause for cancellation of the application and/or for separation from the company if I have been employed.

Signature *

Reset Signature

Signature is required.

Date *

APPLICATION QUESTIONS

Please answer all questions.

Why does this position interest you?

Which of the jobs you have held did you like most, least and why?

What tasks on your last job did you particularly do well, or what was your greatest success/strengths at your previous jobs, and why do you feel this way?

What tasks about your previous job/jobs did you find most difficult and why?

How flexible do you feel you are in most situations?

What kind of people do you like to work with? What kind of people do you find it difficult to work with? Have you been able to successful work with this type of person in the past?

What are some of the things your previous boss did that you particularly liked or disliked?

What do you want from your next job that you are not getting from your previous job?

What specific strengths do you feel you can bring to this position?

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