FAB Job Application Form

Fifth Avenue Baptist Nursery and Preschool

Please complete the form below to apply for a position with us.
Date Applied:*

MonthDayYear
Date
Full Name*

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Phone Number*
Have you ever applied for employment with us?*

YesNo
If hired, could you given written evidence of a right to work in this country?*

YesNo
Have you ever been convicted of a felony?*

YesNo
Are you 18 years of age?*

YesNo
Do you have a valid WV drivers' license?*

YesNoMy drivers license if issued through a different state
Do you have a current first aid certification*

YesNo
Do you have a current CPR certification*

YesNo
Do you type?*

YesNo
What office or data processing machines can you operate?*
What experience do you have working with young children?*
What languages do you speak?*
Type of Employment Desired:
Which position are you interested in? Select all that apply. *
Available Start Date*

MonthDayYear
Date
What is your desired salary?
Education:
Do you have a high school diploma?*

YesNoNo, I am currently in high school
Highest grade completed: *
Colleges Attended:
Degrees Obtained:
Special Trainings: (such as ACDS, EMT, Lifeguard, etc.)
Employment History:

List your last 5 employers beginning with the most recent.
Upload your resume here or fill in employment history below:

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Employer 1:
Employer:
Address:
Phone:
Supervisor Name:
Date employed from:
Identify job title and describe the work:
Reason for leaving:
May we contact?

YesNo
Employer 2:
Employer:
Address:
Phone:
Supervisor Name:
Date employed from:
Identify job title and describe the work:
Reason for leaving:
May we contact?

YesNo
Employer 3:
Employer:
Address:
Phone:
Supervisor Name:
Date employed from:
Identify job title and describe the work:
Reason for leaving:
May we contact?

YesNo
Employer 4:
Employer:
Address:
Phone:
Supervisor Name:
Date employed from:
Identify job title and describe the work:
Reason for leaving:
May we contact?

YesNo
Employer 5:
Employer:
Address:
Phone:
Supervisor Name:
Date employed from:
Identify job title and describe the work:
Reason for leaving:
May we contact?

YesNo
Typical Situations in Childcare Centers

Briefly state your response to the following questions.
1. The teacher has just stepped out of the classroom. The children are playing in the dramatic play area. Two children reach for the same doll. An argument begins and both children hit each other. How would you respond?
2. The teacher is singing with the children during group time. You are putting materials away on the opposite side of the room. After a few minutes, two children lose interest and wander away from the group; distracting other children. How would you respond?
3. You are working as a substitute at the end of the day. As a parent is picking up her child she reads an accident report that states her son received a minor injury. The parent looks at you angrily and comments that this is the second injury her child has received this week. She asks if you are watching the children carefully enough. How would you respond?
4. An aide in the center tells you that a parent is having an illicit affair and continues to elaborate on the details. How would you respond?
Sign below: I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of wages and salary, be terminated at any time without previous notice.

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Should be Empty:

Fifth Avenue Baptist Nursery and Preschool

Type of Employment Desired:

Education:

Employment History:

Employer 1:

Employer 2:

Employer 3:

Employer 4:

Employer 5:

Typical Situations in Childcare Centers