application

Application for Employment with Lakeside Weekday Education Program

Name

First NameLast Name

Today's Date

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

City

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Social Security number

Birthdate

Date

Church Membership

In case of Emergency, who should we notify?

Emergency Contact Phone Number

Format: (000) 000-0000.

Position Applying for

Date Available to Start

Date

Why do you want to work here?

Education Experience: Please list schools attended, dates, and majors

Please list any courses, volunteer work, hobbies or interests that would relate to the position you are applying for

Please list any community organizations you are active in

Name

Dates Employed

Date

Address

Phone

Format: (000) 000-0000.

Salary on leaving

Position

Supervisor's Name

Duties

Reason for leaving

Name

Dates Employed

Date

Address

Phone

Format: (000) 000-0000.

Salary on leaving

Position

Supervisor's Name

Duties

Reason for leaving

Name

Dates Employed

Date

Address

Phone

Format: (000) 000-0000.

Salary on leaving

Position

Supervisor's Name

Duties

Reason for Leaving

References: Please list at least three persons, not related to you, whom you have known at least one year who could attest to your interaction with children. The phone number should be active during the work day.

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

How would you describe your general health?

Are there any physical or personal limitations on the type of work you can do with children at the church, or that would affect the amount of time you can spend at work?

If yes, please explain

Date of your last physical exam

Date

Do you object to being fingerprinted?

Have you ever been convicted of a felony?

Do you have a Driver's license?

Have you ever been convicted of child abuse?

What is your philosophy of early childhood education?

What is your philosophy of behavior guidance?

If hired, what kind of commitment do you expect to be able to give to our program?

What would you say are your goals for the next I to 5 years?

If we were to ask your best friend what he/she thought your 5 best qualities are, what do you think he/she would say?

If we asked that same person what areas you needed to improve upon, what would he/she say?

What age group do you prefer working with?

Is there an age group you absolutely would not want to work with?

Which positions are you interested in?

In compliance with the requirements of this child care program, no person shall be hired or retained as a staff member, paid or volunteer, who has:

a) been convicted of, admitted to, or been the subject of substantial evidence of an act of child abuse or child molestation

b) used alcohol or drugs such that its effects are apparent during working hours that children are in care

c) been convicted of or admitted to any felony or any offense involving moral turpitude.

I am aware that a background study will be performed before I can be hired. I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal.

In the event of my employment, I agree to comply with the rules and regulations governing my employment. In the event I should terminate my employment, I agree to file my resignation two weeks prior to the date it will be effective.

I understand that the first three months of my employment are probationary and that if my services have not proved satisfactory during that time, my employment may be discontinued at any time.

Applicant's Signature

Date

Former Employers