Daycare Staff Application
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Can you pass a background check?
Yes
No
Are you legally authorized to work in the US?
Yes
No
Do you have reliable transportation?
Yes
No
Availability
Full Time
Part-Time
Morning Shift
Afternoon Shift
Flexible
Positions
Lead Teacher
Assistant Teacher
Infant/Todder Caregiver
Floater
Do you have a high school diploma or GED?
Yes
No
Highest Level of Education Completed:
High School Diploma
GED
Some College
Associate Degree
Bachelor’s Degree
Other: ________________________________
Certifications:
CPR
First Aid
CDA
Other: ________________________________
Employer 1 (Provide name, position, dates of employment and reason for leaving)
Employer 2 (Provide name, position, dates of employment and reason for leaving)
Childcare Experience
0–1 years
2–3 years
4–5 years
5+ years
Reference 1 (Provide name, number and relationship)
Reference 2 (Provide name, number and relationship)
Additional info you would like to provide
I certify that the information provided is true and complete. I understand that false information may result in disqualification of employment.
Continue
Continue
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