Shaw_Crest_Academy_Application_with

Position Applying For

Date of Application

Date

Available Start Date

Date

Preferred Employment Type:

Full-TimePart-Time

Full Name

Address

City

State

ZIP

Phone

Email

example@example.com

Birthdate (Required for Background Check)

Emergency Contact

Phone

Educational Level

Check All ECE Coursework & Other Certifications That Apply

Employer Name

Position Title

Start Date

Date

End Date

Date

Supervisor Name Contact

Reason for Leaving

May we contact this employer?

YesNo

Employer Name

Position Title

Start Date

Date

End Date

Date

Supervisor Name Contact

Reason for Leaving

May we contact this employer?

YesNo

Name

Phone

Relationship

Name

Phone

Relationship

Phone

Relationship

Have you ever been employed in a licensed childcare facility in Georgia?

YesNo

If yes name of facility

Have you ever been dismissed, asked to resign, or suspended from a position?

YesNo

If yes please explain

Have you ever been convicted of a crime (misdemeanor or felony)?

YesNo

If yes describe circumstances a conviction does not necessarily disqualify you

Are you legally eligible to work in the United States?

YesNo

1 What age group do you enjoy working with most and why

2 Describe your approach to positive discipline and classroom management

3 What makes a childcare center highquality in your opinion

4 Why do you want to work at Shaw Crest Academy

Applicant Certification & Signature

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that false or misleading information may result in disqualification or termination of employment. I authorize Shaw Crest Academy, LLC to verify my background, references, and qualifications as required for employment at a licensed childcare center in Georgia.

I have never been shown by credible evidence, e.g., a court or jury, a department's investigation, or other reliable evidence to have abused, neglected, or deprived a child or adult or to have subjected any person to serious injury as a result of intentional or grossly negligent misconduct as evidenced by an oral or written statement to this effect obtained at the time of application.

I have read the description of the position for which I am applying, and I am, in all respects, able to adequately perform the duties as described.

Signature

Date

Date Received

Date

Interview Date

Date

Position Offered

Start Date

Date

Approved By

Personal Information

Education & Training

Employment History (Begin with Most Recent)

References