Teacher Application Form

Employee Application
Application Date*

MonthDayYear
Date
Personal Information
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number
Please enter a valid phone number.
Email
example@example.com
Social Security Number
Driver's License Number
Are you of the age 18 or older?

YesNo
Are you a U.S. Citizen?

YesNo
In Case of Emergency, contact:
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you under a doctor's care?

YesNo
If yes, please explain:
Are you able to lift up to 25 lbs?

YesNo
If no, please explain:
Position applying for:
Preferred age group:
Expected Salary:
Hours/Days you cannot work:
Will you have a child attending DWS?

YesNo
Educational Background
High School Name
Received Diploma or Equivalent?

YesNo
College Name
Received Diploma or Equivalent?

YesNo
Degree / Major
Postgraduate College Name
Received Diploma or Equivalent?

YesNo
Degree / Major
Employment History

Please list previous employment, starting with most recent (you may attach a resume with additional information)
Are you presently employed?

YesNo
May we contact the individuals below for reference to your work?

YesNo
If no, please explain
Place of employment
Position
Duties
Start Date

MonthDayYear
Date
Ending Date

MonthDayYear
Date
Supervisor
Phone Number
Please enter a valid phone number.
Reason for Leaving
Place of employment
Position
Duties
Start Date

MonthDayYear
Date
Ending Date

MonthDayYear
Date
Supervisor
Phone Number
Please enter a valid phone number.
Reason for Leaving
Place of employment
Position
Duties
Start Date

MonthDayYear
Date
Ending Date

MonthDayYear
Date
Supervisor
Phone Number
Please enter a valid phone number.
Reason for Leaving
Please list 3 personal references (not related)
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have any special skills or talents that would be beneficial in working with young children? (Please include administrative, organizational, and communication skills.)
What 3 words describe your personality? (Describe their importance in a children's ministry program.)
By completing this application, you give permission for Dilworth United Methodist Weekday School to contact your references, verify your past work history, conduct a criminal background check, verify your driving record, and contact your previous employers to determine your suitability in working at Dilworth United Methodist Weekday School. By signing this application, you affirm that the information is true to the best of your knowledge. You also agree to release the center for any liabilities that result from the verification. Thank you.
Name

First NameLast Name
Date

MonthDayYear
Date
Signature

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Employee Application

Personal Information

Educational Background

Employment History