Childcare Facility Job Application Form

Childcare Facility Job Application Form

Please fill out this application form to apply for a position at our childcare facility. Provide accurate information to help us understand your qualifications and suitability.
Full Name

First NameLast Name
Date Of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Childcare work experience
Are you willing to undergo fingerprinting and background check? (verification of CCCBC required)
Are you legally authorized to work in the U.S.?
Do you have reliable transportation?
Education
Position Applying For
Highest Grade Level Completed
Desired Hours
Willingness to work early mornings (6:30am) or late afternoons (5:30pm)
If No, please explain
Are you able to wait until our opening date? (March 2026)
Are you able to lift 35+ lbs and meet physical job requirements?
Mandated Reporter Training Completed?
Safe sleep training completed?
Medicine Administration Certificate
List Other Certification
Health & Safety Orientation Completed?
Describe your relevant experience in childcare
Please provide the names and contact details of two references
Upload any certifications related to childcare or first aid (e.g., CPR, First Aid Certificate)

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What age groups have you worked with? What age do you prefer?
What motivates you to work in childcare?
Describe your approach to child safety and care
I certify that all information provided is true and complete.
Signature
Date

MonthDayYear
Date
For Office Use Only
Hire Date

MonthDayYear
Date
First Day onsite working with children

MonthDayYear
Date
Should be Empty:

Childcare Facility Job Application Form

For Office Use Only