WonderWell - Enrollment Form

Name *

Last, First, Middle Initial

E-mail Address *

Primary Phone Number *

Area Code Phone Number

Secondary Phone Number

Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Desired Position *

Primary Teacher Primary Co-Teacher Pre-Kindergarten Teacher Pre-Kindergarten Co-Teacher After School Program Staff

Date Available to Start *

Are you available to work from 7:15 am to 3:45 pm (Teacher), 7:30 am - 4:00 pm (Co-Teacher), or 2:30-5:30 pm (After School Program Staff)? *

Yes No

How did you hear about us?

What is the highest degree or level of school you have completed? *

High school diploma or equivalent Associate degree Undergraduate degree Graduate degree

Name of school(s), years attended, area(s) of study:

Work Experience - Most Recent Employment Experience

Employer Name *

Employer Number *

Area Code Phone Number

Employer Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Supervisor's Name *

First Name Last Name

How long did you work there? *

May we contact this employer? *

Yes No

Position Held *

Reason for leaving *

General Job Responsibilities *

Work Experience - Job Two

Employer Name *

Employer Number *

Area Code Phone Number

Employer Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Supervisor's Name *

First Name Last Name

How long did you work there? *

May we contact this employer? *

Yes No

Position Held *

Reason for leaving *

General job responsibilities *

Work Experience - Job Three

Employer Name *

Employer Number *

Area Code Phone Number

Employer Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Supervisor's Name *

First Name Last Name

How long did you work there? *

May we contact this employer? *

Yes No

Position Held *

Reason for leaving *

General job responsibilities *

Who or what influenced you to become an early childhood educator? *

What traits and characteristics do you believe an early childhood educator in a Reggio Emilia inspired school should have? *

Why do you want to teach at WonderWell? *

What contributions do you believe you could make to WonderWell? *

Please provide any additional information you believe should be considered for employment at WonderWell. *

Are you over 18, and can you provide proof of age? *

Yes No

Are you a U.S. citizen or have appropriate documentation to show you are eligible to work in the U.S? *

Yes No

Are you related to any child enrolled in this program? *

Yes No

Child's name

Relation to child

Have you ever been arrested? *

Yes No

Have you ever been charged with a crime against a child? *

Yes No

Have you ever been convicted of a crime against a child? *

Yes No

Have you ever been charged or convicted with any crime (felony or misdemeanor)? *

Yes No

Do you have any pending criminal charges against you including deferred adjudication? *

Yes No

If you answered "Yes" to any of the questions above, please explain:

Please provide your social security number in the field below. This will be used for criminal history and background check purposes only.

social security number

References

Please list three people, unrelated to you, who know your qualifications and fitness for the position for which you are applying. References must include your student teacher supervisor (if you are approaching your college graduation), your current or most recent school director or principal (who directly supervised your most recent teaching position), and former supervisors.

Reference One - Most Recent Supervisor, School Director, or Principal

Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Relationship *

Profession *

Reference Two

Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Relationship *

Profession *

Reference Three

Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Relationship *

Profession *

Please use the space below if you wish to provide details of circumstances or qualifications not reflected in the application: *

Upload Cover Letter Here *

Upload Resume Here *

Upload College Transcript Here *

Upload Educator Certificate Here

Upload Additional Transcripts, Certifications, or Documentation Here

Applicant Statement

I certify that the answers and information given herein are true, correct, and complete. I authorize investigation of all statements contained in this application for employment, as may be necessary in arriving at an employment decision. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in termination regardless of when the information is discovered to be false or misleading. I understand that WonderWell will not do a Risk Evaluation if the TDPRS Criminal History Background Check requires such, and any offer of employment will be null and void.

Thank you for your interest in being employed with WonderWell. Upon review of completed applications, a representative of WonderWell will schedule interviews with applicants who meet the initial requirements, as evidenced by the information provided herein.

Please type your full name below to represent your electronic signature:

Signature

Date

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