Application for Employment

Application for Employment
Name: Last, Middle, First*
Date of Application*

MonthDayYear
Date
Current Address*
Best Phone Number to be Reached at*
Email*
example@example.com
Thank you for choosing Dynasty Child Care in your career path. We are dedicated to hiring professionals who are energetic, motivated, and possess integrity. Dynasty Child Care is an Equal Opportunity Employer. Applicants must show they understand and are able to meet the following requirements for employment by initialing each item below.
High School Graduate or GED recipient
*Initials
Negative TB Test and will provide current Physical
*Initials
United States Citizen or Legally authorized to work in the United States
*Initials
Will provide Social security or Birth Certificate
*Initials
Will complete a criminal background check
*Initials
Physically able to safely supervise young children and perform necessary job duties
*Initials
Will maintain professional appearances and conduct at all times
*Initials
Employment Desired: Check One*

-Full time-Part time
Position Desired example: Toddler Infant, Preschool, or Pre-k Teacher *
Hourly Rate Desired*
Hours Available

Monday-Friday
Mon*
Tue*
Wed*
Thur*
Fri*

3 Personal References (do not list family)*

	Name	Phone Number	Relationship
Reference 1
Reference 2
Reference 3

Educational Experiences
High School attended/year graduated*
College attended/ Degree or number of years completed/ Major*
Child Development Associate Certificate*
List course completed or relevant childcare trainings (CPR, First aid, Child Development etc.)*
List other skills, vocational and technical training*
Employment History

*(begin with most recent)

	Beginning and End date	Employer	Supervisor's name and Phone	Your title(s) and duties	Reasoning for leaving
Employer 1
Employer 2
Employer 3

Offenses

Criminal background will be conducted on all applicants
Have you ever pled guilty, no contest, or been convicted of any criminal offense? If yes, Explain:*
Has a report of child maltreatment ever been made against you? If yes, Explain:*
Has a court ever denied parental, custodial, or visitation rights as a result or neglect or abuse of a child? If yes, Explain:*
While employed in a childcare program have you ever been the subject of disciplinary action or been responsible for a child care facility receiving an administrative or disciplinary action? If yes, Explain: *
Please answer the following questions:
What are your career goals and objectives?*
Why should Dynasty Child Care hire you?*
Define PROFESSIONAL CONDUCT and how does it apply to a childcare program?*
Define CUSTOMER SERVICE and how does it relate to a child care program?*
Describe your position on guidance as it relates to 3-year-old children arguing over a toy.*
An application form sometimes makes it difficult to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the position you are applying for.*
I First Name* Last Name* hereby certify that all the information contained in this application is true and correct. I understand that any misrepresentation, falsification or consequential omission of information may render this application void, or if employed may result in immediate termination. I consent and agree to submit to any job related medical exams that might be required and agree to provide any information that may be needed to facilitate such a test. I authorized the individuals and institutions named above to give information regarding my employment, character and qualification, hereby releasing them from all liability for issuing such information.
Printed Name of Applicant*
Signature of Applicant*

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Application for Employment

Hours Available

Educational Experiences

Employment History

Offenses

Please answer the following questions: