Preschool

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Preschool

Employment Application



Date: ________________________ Name: _______________________________________________________________________________________ Address: _____________________________________________________________________________________ Telephone: ___________________________ Email Address: __________________________________________ Date of Birth: _________________________ Position Applying For: Teacher Teacher Aide Substitute Teacher/Aide Summer Cook Date you are able to begin working: ________________________ Wage desired: _________________________ Education: Diploma/GED (required for employment): Yes No College(s) attended: ___________________________________________________________________ Total College hours earned: _________ Early Childhood hours earned: _______ Degrees earned: _______________________________________________________________________ Work History: (List most recent first) Employer: ____________________________________________________________________________ Address: _____________________________________________________________________________ Telephone: __________________________ Supervisor: _______________________________________ Dates employed: ________________________________ Position: ______________________________ Reason for leaving? ___________________________________ May we contact employer? Yes No Employer: ____________________________________________________________________________ Address: _____________________________________________________________________________ Telephone: __________________________ Supervisor: _______________________________________ Dates employed: ________________________________ Position: ______________________________ Reason for leaving? ___________________________________ May we contact employer? Yes No



Employer: ____________________________________________________________________________ Address: _____________________________________________________________________________ Telephone: __________________________ Supervisor: _______________________________________ Dates employed: ________________________________ Position: ______________________________ Reason for leaving? ___________________________________ May we contact employer? Yes No References: Name: ___________________________________________ Phone Number: _____________________ How long have you known this person? ____________________________________________________ Relationship to this person? _____________________________________________________________ Name: ___________________________________________ Phone Number: _____________________ How long have you known this person? ____________________________________________________ Relationship to this person? _____________________________________________________________ Name: ___________________________________________ Phone Number: _____________________ How long have you known this person? ____________________________________________________ Relationship to this person? _____________________________________________________________ Are you current on any of the following: • • • •

Gateways Credential? Standard First Aid Card? Infant-Child Cardiopulmonary Resuscitation Card? Tubercular Test (TB) result?

Yes Yes Yes Yes

No No No No

I certify that the above is true and correct to the best of my knowledge. I understand that untruthful or misleading answers are cause for rejection of my application or dismissal if employed. I authorize an investigation of statements contained in this application which will allow the employer to make an employment decision. Signature________________________________________________________________Date______________________________ For Office Use Only Interview Date_________________ Position ___________________________________________ Comments_______________________________________________________________________ _____ Background Check complete





_____ Employment Packet complete