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.
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)*

YesNo
Are you legally authorized to work in the U.S.?*

YesNo
Do you have reliable transportation?*

YesNo
Education*
Position Applying For*
Highest Grade Level Completed*
Desired Hours*
Willingness to work early mornings (6:30am) or late afternoons (5:30pm)*

YesNo
If No, please explain
Are you able to wait until our opening date? (March 2026)*

YesNo
Are you able to lift 35+ lbs and meet physical job requirements?*

YesNo
Mandated Reporter Training Completed?*

YesNo
Safe sleep training completed?*

YesNo
Medicine Administration Certificate*

YesNo
List Other Certification
Health & Safety Orientation Completed?*

YesNo
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)

Cancelof
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.*

I Agree
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