Blessings Academy Early Learning Center Employment Application
Applicant Information
Applicant Full Name
*
First Name
Middle Name
Last Name
Preferred Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Street Address
*
City, State, Zip
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Position and Availability
Position Applying For
*
Lead Teacher
Assistant Teacher
Floater
Nutritionist
Other
Other Position
Desired Start Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Desired Hourly Rate
*
Employment Type
*
Full-Time
Part-Time
Substitute
Days Available
*
Mon
Tue
Wed
Thu
Fri
What hours are you available to work? (Center Hours: 7:00am - 5:30pm)
*
Work Eligibility and Experience
Previously employed by a childcare center?
*
Yes
No
Years of childcare center experience
*
Highest level of education completed
*
High School Diploma/GED
CDA
Associate Degree
Bachelor’s Degree
Master’s Degree
Field of study
*
School / Institution
*
Certifications
Child Development Associate (CDA)
Early Childhood Education Certification
First Aid / CPR
CLASS Certified
Teaching Strategies GOLD
Other
Childcare experience description
*
Preferred age group
*
Infants
Toddlers
Preschool
Flexible
Employment History
Employer 1
*
Employer 2
*
Employer 3
Eligibility, Background, and Transportation
Are you authorized to work in the United States
*
Yes
No
Are your willing to submit to background checks and fingerprinting
*
Yes
No
Have you ever been convicted of a crime
*
Yes
No
If yes, explanation of conviction
Do you have reliable transportation to get to work
*
Yes
No
References and Signature
Reference 1 Name
*
First Name
Last Name
Reference 1 Relationship
*
Reference 1 Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 1 Email
example@example.com
Reference 2 Name
*
First Name
Last Name
Reference 2 Relationship
*
Reference 2 Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 2 Email
example@example.com
Reference 3 Name
*
First Name
Last Name
Reference 3 Relationship
*
Reference 3 Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 3 Email
example@example.com
Reference 4 Name
First Name
Last Name
Reference 4 Relationship
Reference 4 Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 4 Email
example@example.com
Applicant Statement & Authorization
I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any false information may result in disqualification from employment or termination if hired. I authorize Blessings Academy Early Learning Center to verify the information provided, including contacting references and conducting background checks as required by Louisiana Law. I release all persons who disclose such information from any liability or damages to me or anyone acting in my name. I waive any written notice of the release of such information that may be required by any state or federal law.
Applicant Signature
*
Application Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Application
Submit Application
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