Phone number
Phone type Mobile Home Work Other
Are you legally entitled to work in the United States and meet the qualifications listed above?
Allergies/Medical Information
Name of School/Dates Attended/Diploma or Degree
Name of School/Dates Attended/Diploma or Degree
Please describe any previous employment related to teaching or the care of children. Please include length of employment and roles/responsibilities held.
Name & email address of previous employers listed above. They may be contacted if we have any questions or want further information.
Please list any other experience you have had with preschoolers that may be beneficial to you in applying for this position.
Check general condition of your health.
List any health-related conditions which would prevent you from performing certain types of activities in working with young children.
Have you ever used illegal drugs?
Have you ever been arrested and/or convicted of any offense against the law? (you may omit minor traffic violations)
Have you ever been accused, charged or alleged to have committed any act of neglecting, abusing or molesting a child?
If yes, please explain in detail, providing date and place.
What age child are you most comfortable caring for? Check all that apply.
Are there any ages that you are not comfortable caring for? If so, please list below.
Name of church you are attending:
Summarize how you came to know Jesus Christ as your personal savior.
How would you describe your relationship with Jesus at this time?
Submit
