Shaw_Crest_Academy_Application_with

Position Applying For
Date of Application

MonthDayYear
Date
Available Start Date

MonthDayYear
Date
Preferred Employment Type:

Full-TimePart-Time
Personal Information
Full Name
Address
City
State
ZIP
Phone
Email
example@example.com
Birthdate (Required for Background Check)
Emergency Contact
Phone
Education & Training
Educational Level
Check All ECE Coursework & Other Certifications That Apply

TCC/TCDFire SafetyCDA (Child DevelopmentAssociate)CPR/First AidMandated Reporter Training
Employment History (Begin with Most Recent)
Employer Name
Position Title
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Supervisor Name Contact
Reason for Leaving
May we contact this employer?

YesNo
Employer Name
Position Title
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Supervisor Name Contact
Reason for Leaving
May we contact this employer?

YesNo
References

At least two from the childcare or education field preferred.
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.
Signature

Clear
Date

MonthDayYear
Date
Date Received

MonthDayYear
Date
Interview Date

MonthDayYear
Date
Position Offered
Start Date

MonthDayYear
Date
Approved By
Should be Empty:

Personal Information

Education & Training

Employment History (Begin with Most Recent)

References