Little-ones Love to Learn, Inc
Child Care & Education Center
Employment Application
Little-ones Love to Learn, Inc - Child Care & Education Center
Print clearly. Complete all sections. Incomplete applications may be screened out.
1) Applicant Profile
Legal Name:
Preferred Name:
Address:
City/State/ZIP:
County (if applicable):
Phone:
Format: (000) 000-0000.
Alt Phone:
Format: (000) 000-0000.
Email:
example@example.com
Are you 18 or older?
Yes
No
Are you legally authorized to work in the U.S.?
Yes
No
(If hired, you must provide documentation for I-9 verification.)
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Emergency Contact Name:
Relationship:
Emergency Contact Phone:
Format: (000) 000-0000.
Emergency Contact Email:
example@example.com
2) Role Alignment and Availability
Position Applying For:
Preferred Start Date:
-
Month
-
Day
Year
Date
Desired Status:
Full-time
Part-time
On-call
Wage/Salary Expectation (optional):
Days available (check all):
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Shift availability (check all):
Open (early AM)
Mid
Close (late PM)
Split shift
Flexible
Hours you can work (From):
Hour Minutes
AM
PM
AM/PM Option
To:
Hour Minutes
AM
PM
AM/PM Option
Any scheduling restrictions we should plan around:
Able to work overtime if needed?
Yes
No
Able to meet consistent attendance expectations (core operational requirement)?
Yes
No
3) Education and Early Childhood Qualifications
Highest level completed (check one):
Some High School
High School Diploma
GED
Some College
Associate's
Bachelor's
Master's/Graduate
School/Program:
City/State:
Degree/Major (if applicable):
Graduation Year:
-
Month
-
Day
Year
Date
Early Childhood Credentials (check all that apply):
CDA
ECE Certificate
ECE Degree
Montessori
Special Education
Other
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Do you have official transcripts available (if required by licensing/role)?
Yes
No
4) Required Health, Safety, and Credentialing
A) CPR / First Aid (Required for most roles)
CPR Certification Obtained?
Yes
No
In progress (not acceptable for independent classroom coverage)
Type (check all):
Pediatric CPR
Adult CPR
First Aid
AED
Issuing Organization:
Certification # (if shown):
Issue Date:
-
Month
-
Day
Year
Date
Expiration Date:
-
Month
-
Day
Year
Date
Do you have a copy of your CPR/First Aid card/certificate to submit?
Yes (attach)
No (must provide
B) Training Clock Hours Documentation
Do you have copies of completed training clock hours/certificates?
Yes (attach)
Some (attach what
No (may delay onboarding/eligibility)
List your most recent clock hours/training (attach additional pages if needed):
Rows
Course/Topic
Hours
Date Completed
Proof Attached (Y/N)
1
2
3
4
Common topics (check if completed):
Child Abuse Prevention/Mandated Reporting
Health & Safety/Universal Precautions
Safe Sleep (if
CPR/First Aid
Emergency Preparedness
Medication Administration (if applicable)
Positive Guidance/Behavior Support
Developmentally Appropriate Practice
ADA/Inclusion/Special
Needs
Licensing Orientation
Other
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5) Compliance and Risk Controls (Background Checks / Licensing)
A) CCBC Checks (Child Care Background Check)
Yes
No
Not sure
State/Agency:
Date Submitted:
Status:
Cleared
Pending
Expired/Needs renewal
Tracking/Authorization Number (if available):
Yes
No
B) Licensing / Employment Restrictions (Child-Safety Focus)
Yes
No
Explain:
Yes
No
Explain:
Yes
No
Explain:
(Employment is contingent on meeting all licensing standards and passing required screenings as permitted by law.)
6) Employment History (Include "Last Center Worked")
Start with your most recent job. Attach a resume if available (still complete this section).
Most Recent Employer / Last Center Worked
Employer/Center Name:
Address:
Phone:
Format: (000) 000-0000.
Supervisor/Director Name:
Your Job Title:
Dates Employed (From):
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Dates Employed (To):
Reason for Leaving:
May we contact this employer?
Yes
No
If No, explain:
Primary Duties (be specific):
Ages served (check all):
Infant
Toddler
Preschool
School-age
Max children supervised at once:
Typical ratio:
Prior Employer 1
Employer Name:
Phone:
Format: (000) 000-0000.
Supervisor Name:
Job Title:
Dates Employed (From):
Dates Employed (To):
Reason for Leaving:
May we contact?
Yes
No
Prior Employer 2
Employer Name:
Phone:
Format: (000) 000-0000.
Supervisor Name:
Job Title:
Dates Employed (From):
Dates Employed (To):
Reason for Leaving:
May we contact?
Yes
No
Any gaps in employment of 30+ days?
No
Yes
Explain:
7) Child Care Experience Portfolio
Check all settings you've worked in:
Licensed Center
Family Child Care
School/Head Start
Nanny/In-home
Camp/After-school
Core competencies (check all that apply):
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Lesson planning / curriculum implementation
Classroom management / positive guidance
Parent communication
Diapering/toileting routines
Meal/snack service following allergy protocols
Developmental screening/observations/documentation
Special needs/inclusion supports
Safe sleep practices (infants)
Playground/outdoor supervision
Opening/closing procedures and compliance logs
Briefly describe your approach to child guidance and classroom culture:
Briefly describe any experience with licensing compliance (ratios, supervision, incident reporting):
8) Professional References (Non-family preferred)
Name:
Relationship:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Name:
Relationship:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Name:
Relationship:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
9) Driving / Transport (Complete if role may involve transport)
Do you have a valid driver's license?
Yes
No
State:
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Do you have reliable transportation to work?
Yes
No
Any moving violations in the last 3 years?
No
Yes
Explain:
(Driving roles may require MVR review and additional insurance/eligibility steps.)
10) Operational Requirements Acknowledgment
Physical / role requirements (check):
I can lift and carry up to lbs (typical childcare need: 25-50 lbs) with or without accommodation.
I can sit/stand/floor-play, bend, and move quickly for child supervision with or without accommodation.
I can perform continuous active supervision (core safety requirement).
Do you need a reasonable accommodation to perform essential job functions?
No
Yes
Describe:
11) Attestations, Authorizations, and Releases
Read carefully and initial each item:
Accuracy Statement: I certify the information provided is true, complete, and accurate. I understand false or misleading information may result in disqualification or termination.
Reference Check Authorization: I authorize the center to contact my employers, supervisors, and references and to verify my work history, education, and credentials as permitted by law.
Background Check Consent (CCBC and other required screenings): I understand employment is contingent upon completing and passing all required childcare background checks and licensing screenings, including CCBC (or equivalent), fingerprints, and registry checks as required by the state/licensing authority.
Policy Alignment: I understand I must follow all center policies, including child supervision, safe sleep (if applicable), mandated reporting, confidentiality, and code of conduct.
At-Will Employment (if applicable in your state): I understand that if hired, employment is not for a fixed term and may be ended by me or the center at any time, with or without notice, consistent with applicable law.
12) Applicant Signature
Signature:
Date:
-
Month
-
Day
Year
Date
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Printed Name:
Attachments Checklist (Submit with Application)
Resume (optional but preferred)
Copy of CPR/First Aid card/certificate
Copies of training clock hours/certificates
Transcripts/credential documentation (if applicable)
Any additional relevant certifications (e.g., medication administration, CDA, etc.)
For Internal Use Only (Center Staff)
For Internal Use Only (Center Staff)
Rows
Interviewer:
Position Level:
CCBC:
CPR Verified:
Clock Hours Verified:
References Checked:
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Submit
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