Pre-Interview Questionnaire
Name
First name Last name
Preferred pronouns
Date of Birth
*
/
Month
/
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
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The PlayArts After School Teacher role is a part-time position at approximately 18-22 hours per week. The shift requires employees to work consistently Monday 1:30pm - 6:15pm, and Tuesday - Friday 3:00pm - 6:15pm. Does a part-time position with these hours work for you?
*
Yes, I understand it is part time and, if hired, will be available to work the above shifts
No, I am not available for these shifts, but would be interested in being contacted for an as-needed substitute position
The PlayArts After School Teacher Position pays on a range of $19 - $22 / hour, based on your interview, childcare or teaching experience, and reference checks. Does this pay range work for you?
*
Yes, I can accept this pay range
What is the highest level of education you have obtained? NOTE: PlayArts requires a High School Diploma plus at least 2 years of experience, or a combination of experience and early childhood education from an accredited school to be considered for employment.
*
High School Diploma / GED
Associate Degree
Bachelor's Degree (non-education)
Master's Degree
Doctorate Degree
Currently working towards a degree
If you selected "currently working towards a degree", please elaborate on what level of education you are working towards, and your estimated graduation date.
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Childcare Employment History
As a licensed provider, PlayArts' staff must have a minimum of TWO (2) YEARS (2,500 hours) of verifiable childcare or teaching experience, as required by PA state law. Please complete the questions below to determine your eligibility for hire. If hired, any listed employers must complete an employment verification form for your file. Input as many verifiable, childcare jobs as is needed to add up to two (or more) full years. PLEASE DO NOT ADD JOBS THAT ARE NOT CHILDCARE OR TEACHING-RELATED: THEY ARE NOT APPLICABLE FOR THE PURPOSES OF THIS FORM. Please start with any CURRENT or MOST RECENT work experience.
Name of Employer
*
Job Title
*
Type of work responsibilities (i.e. preschool teacher, camp instructor, childcare, babysitting, nannying, swim lessons, family childcare etc.)
*
Do you still currently work in this role?
Yes
No
Other
Enter the approximate dates you worked for the above employer. (If seasonal work i.e. lifeguarding, please enter each season as a separate entry). If you are still currently working for this employer, please still put the "To:" date as today's date.
From:
*
-
Month
-
Day
Year
Date
To:
*
-
Month
-
Day
Year
Date
Total number of hours per week (on average) that you worked during this period.
*
Number of months worked
Hours per month
Total hours worked during this period
Total Years Worked for this employer:
Would you like to add another employer? (Please note, your total experience must be at least two (2) years combined for all childcare experience (both formal and informal), and your salary will be calculated based on your total overall years of FORMAL childcare experience)
Please Select
Yes
No
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Childcare Employment History
(Employer 2)
Name of Employer
*
Job Title
*
Type of work responsibilities (i.e. preschool teacher, camp instructor, childcare, babysitting, nannying, swim lessons, family childcare etc.)
*
Enter the approximate dates you worked for the above employer.
From:
*
To:
*
Total number of hours per week (on average) that you worked during this period.
*
Number of months worked
Hours per month
Total hours worked during this period
Total Years Worked for this employer:
Total Years Worked for all employers combined:
Would you like to add another employer?
Please Select
Yes
No
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Childcare Employment History
(Employer 3)
Name of Employer
*
Job Title
*
Type of work responsibilities (i.e. preschool teacher, camp instructor, childcare, babysitting, nannying, swim lessons, family childcare etc.)
*
Enter the approximate dates you worked for the above employer.
From:
*
To:
*
Total number of hours per week (on average) that you worked during this period.
*
Number of months worked
Hours per month
Total hours worked during this period
Total Years Worked for this employer
Total Years Worked for all employers combined:
Would you like to add another employer?
Please Select
Yes
No
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Childcare Employment History
(Employer 4)
Name of Employer
*
Job Title
*
Type of work responsibilities (i.e. preschool teacher, camp instructor, childcare, babysitting, nannying, swim lessons, family childcare etc.)
*
Enter the approximate dates you worked for the above employer.
From:
*
To:
*
Total number of hours per week (on average) that you worked during this period.
*
Number of months worked
Hours per month
Total hours worked during this period
Total Years Worked for this employer:
Total Years Worked for all employers combined:
Would you like to add another employer?
Please Select
Yes
No
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Childcare Employment History
(Employer 5)
Name of Employer
*
Job Title
*
Type of work responsibilities (i.e. preschool teacher, camp instructor, childcare, babysitting, nannying, swim lessons, family childcare etc.)
*
Enter the approximate dates you worked for the above employer.
From:
*
To:
*
Total number of hours per week (on average) that you worked during this period.
*
Number of months worked
Hours per month
Total hours worked during this period
Total Years Worked for this employer:
Total Years Worked for all employers combined:
Would you like to add another employer?
Please Select
Yes
No
Back
Next
Childcare Employment History
(Employer 6)
Name of Employer
*
Type of work responsibilities (i.e. preschool teacher, camp instructor, childcare, babysitting, nannying, swim lessons, family childcare etc.)
*
Enter the approximate dates you worked for the above employer.
From:
*
To:
*
Total number of hours per week (on average) that you worked during this period.
*
Number of months worked
Hours per month
Total hours worked during this period
Total Years Worked for this employer:
Total Years Worked for all employers combined:
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Have you lived outside of Pennsylvania in the last five (5) years (60 months)?
*
Yes
No
If you selected "yes", please list the state(s) in which you have lived during the past five (5) years. If you have only lived in the state of PA, please put "NA".
*
If, in the past five (5) years you have resided in a state outside of PA, the Office of Child Development & Early Learning (OCDEL) requires clearances from these states for you to be eligible to work in our after school programs. Please check the appropriate box(es).
*
(Out of State) Criminal Record / Background Check
(Out of State) Child Abuse Registry Check
(Out of State) Sex Offender Registry Check
I have only resided in the state of PA for the past five (5) years
I do not have these out-of-state clearances, but I am willing to get them
Other
Are you prepared to obtain all the necessary clearances/trainings that are needed for this role?
*
Yes
No
Other
What is the earliest date that you can begin working?
*
Please provide at least THREE (or more) days and timeframes that you can interview in the next 7-10 days. If you only provide one day/time, you will be asked to resubmit this form again.
*
Do you currently have, or have you started the process for obtaining your NSOR (National Sex Offender Registry) clearance?
*
Yes
No
Other
Please provide at least TWO (or more) professional references: MUST include full names, email addresses, and phone numbers. If any information is missing, you will need to resubmit this form again.
*
Submit
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