Daycare Application Form
Thank you for your interest in and application for employment with 10 Fingers 10 Toes. We are an equal opportunity employer and give employment and promotional consideration without regard to race, color, gender or gender identity, religion, age, or disability. We seek applicants for employment who are dedicated, hardworking and seek fulfilling employment. In return, 10 Fingers 10 Toes offers competitive income, an enchanting working environment and the opportunity to grow within our preschool environment.
Full name of employee
Last Name
First Name
Middle Initial
Present Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Permanent Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Referred By
Have you ever been excluded from federal health care programs by the inspector general of the Department of Health and Human Services?
Yes
No
Have you ever been convicted of a serious misdemeanor or felony crime?
Yes
No
Position for which application is being made (Be Specific)
I am available to work (Check All Applicable)
Full Time
Part Time
Temporary
Mornings
Afternoons
Evenings
Date Available
example@example.com
Salary Desired
example@example.com
Are you employed?
Yes
No
If yes, may we contact your current employer?
Yes
No
Are you presently working in early childhood?
Yes
No
If yes, how many years of experience in education
High School
College
Trade or Business School
General Information
Highest Level of Education Attained
example@example.com
Major Field of Study
example@example.com
Years Attended
example@example.com
Did you graduate?
Yes
No
Subjects of Special Study/ Research Work/ Special Training /Skills
Employment History
Employer #1
Date
Employer Name
Salary
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reason for Leaving
Employer #2
Date
Employer Name
Salary
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reason for Leaving
Employer #3
Date
Employer Name
Salary
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reason for Leaving
Employer #4
Date
Employer Name
Salary
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reason for Leaving
References
Reference #1
First Name
Last Name
Phone Number
Please enter a valid phone number.
Years Acquainted
Reference #2
First Name
Last Name
Phone Number
Please enter a valid phone number.
Years Acquainted
Reference #3
First Name
Last Name
Phone Number
Please enter a valid phone number.
Years Acquainted
Authorization
I certify that the facts in the application are true and complete to the best of my knowledge and understand that, if employed falsified statements on this application shall be grounds for dismissal.I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release 10 Fingers 10 Toes from all liability or damage that may result from utilization of such information.I also understand and agree that no representative of 10 Fingers 10 Toes has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA)
Signature of applicant or perspective child care provider
Submit
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