Job Application (2022)

Jenny's House Family DayCare

197 John C. McNamara Dr., Montrose, Pa 18801 | (570)278-2551 | www.JennysHouseFamilyDaycare.com

Employment Application

Please complete all the information on this application and attach a copy of your current resume. The disclaimer must be signed in order for the application to be valid. Please return the completed application, health assessment form and clearances to our center.
Date of Application

MonthDayYear
Date
Personal Information
Name

First NameLast Name
Street Address
City
State
Zip
Email
example@example.com
YesNo
YesNo
Position
Position You are Applying For
Available Start Date

MonthDayYear
Date
Desired Pay
Full TimePart TimeSubstitute
Education
References
Employment History
Clearances
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YesNo
If yes, please fill in the date on the clearances:
FBI Fingerprints

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Date
Child Abuse

MonthDayYear
Date
Criminal History

MonthDayYear
Date
Health Assessment

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Date
TB Test

MonthDayYear
Date
Specific Experience
Do you have specific experience working with children?
If yes, in what setting? (i.e. daycare center, home care, babysitter)
What ages do you have experience with?
YesNo
Have you taken any coursework that pertains to the field of Education?
If yes, please list the trainings or coursework you have completed
YesNo
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information on my application or interview may result in my release.
Signature

Clear
Date

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Date
NOTE: If you are called for an interview, please take some time to familiarize yourself with the Keystone STARS website as well as our website at www.iennyshousefamilydaycare.com as we will be discussing information pertaining to these things during the interview. Thank you for your interest & good luck!
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Personal Information

Position

Education

References

Employment History

Clearances

Specific Experience