Childcare Employment Application
Section 1: Personal Information
Full Name
First Name
Last Name
Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Current Address
Job Position
Please Select
Director
Cook
Teacher
Co-Teacher
Summer Camp
Maintenance
Custodian
Director
Enrollment Specialist
Admin
Van Driver
Tutor
Location
Please Select
Jai Jai's Legacy Academy
Hattie's Child Enrichment Center
Phase II Academy Afterschool
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Social Security Number
Driver’s License Number
Email
example@example.com
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Section 2: Employment Requirements
Employment Requirements
High School Graduate or G.E.D recipient.
Negative TB Test and will provide current medical documentation.
United States Citizen or legally authorized to work in the United States.
Will provide Social Security Card or Birth Certificate.
Will submit to drug and alcohol testing when required.
Will complete an FBI criminal background check (through www.machs.mo.gov).
Will complete a Missouri Family Care Safety Registry check ($15 fee at https://health.mo.gov/safety/fcsr/).
Physically able to safely supervise young children and perform necessary job functions.
Will maintain professional appearance and conduct at all times.
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Section 3: General Information
Employment Desired
Full-Time
Part-Time
On-Call
Night Shift
Day Shift
Position Desired
Hourly Rate Desired
Hours Available
*
Are you seeking temporary or permanent work?
Please Select
Temporary
Permanent
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Section 4: Personal References
3 Personal References (do not list family)
*
Section 5: Educational Experience
High School attended/address/year graduated
College attended/Degree or number of years completed/Major
Do you have a Child Development Associate Certification?
Yes
No
List courses completed or relevant childcare training (CPR, First Aid, Child Development, etc.)
List other skills, vocational, and technical training
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Section 6: Employment History
Employment History (begin with most recent)
*
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Section 7: Offenses
Have you ever pled guilty, no contest, or been convicted of any criminal offense?
*
Yes
No
If yes, explain.
Has a report of child maltreatment ever been made against you?
Yes
No
If yes, explain.
Has a court ever denied parental, custodial, or visitation rights as a result of neglect or abuse of a child?
Yes
No
If yes, explain.
While employed in a childcare program, have you ever been the subject of disciplinary action?
Yes
No
If yes, explain.
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Section 8: Career Questions
What are your career goals and objectives?
Describe your position on guidance as it relates to 3-year-old children arguing over a toy.
Define PROFESSIONAL CONDUCT. How does it apply to a child care program?
Define CUSTOMER SERVICE and how it relates to a child care program.
This job requires 12 clock hours of childcare-related training per year. Do you understand you will be responsible for acquiring this training at your own expense?
Yes
No
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Section 9: Signature and Certification
Print Your Name
Signature of Applicant
Date
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