College Park United Methodist Church Child Development Centre and Primary School

College Park United Methodist Church Child Development Centre and Primary School

Application for Employment

Application Date:________________

Personal Information

Applicant’s Name: _________________________________________________________________

First Middle Last

Home Address_______________________________________________________

Home Phone:__________________________

Alternate Phone:_______________________

Email: _____________________________________________

Social Security #: ______________________

Are you at least 18 years old:______Yes ______No

Employment History

DCF requires we verify your last three employers or last two years of employment. Please provide phone numbers.

1.Company____________________________City/State_______________________

Dates Employed______________________ Business Phone______________________

Job Title____________________________Reason for Leaving__________________

Job Duties __________________________________________________________

2.Company____________________________City/State_______________________

Dates Employed______________________ Business Phone______________________

Job Title___________________________ Reason for Leaving__________________

Job Duties __________________________________________________________

3.Company____________________________City/State_______________________

Dates Employed_______________________Business Phone______________________

Job Title___________________________ Reason for Leaving__________________

Job Duties __________________________________________________________

4.Company____________________________City/State_______________________

Dates Employed______________________ Business Phone______________________

Job Title___________________________Reason for Leaving__________________

Job Duties __________________________________________________________

Educational Background

Have you completed the DCF 40 hour classes? ____________

Do you hold a Child Development Associate (CDA)?___________

School Name Major Date Graduated/Degree

1.__________________________________________________________________________

2.__________________________________________________________________________

3.__________________________________________________________________________

4.__________________________________________________________________________

References

Name Phone Number Years Known

1.____________________________________________________________________________

2.____________________________________________________________________________

3.____________________________________________________________________________

Additional Information

DCF requires all personnel who work with children to be fingerprinted and have a background check to ensure good moral character.

Have you ever been convicted of a felony?_________

Have you ever worked in a facility that has had a licence denied, revoked, or suspended in any state or jurisdiction or has been the subject of a disciplinary action or been fined while employed in a child care facility? ______No ______Yes. If yes, explain:________ _______________________________________________________________________

What age children do you prefer to work with? _____________

How can you contribute to the quality of our Child Development Centre?

__________________________________________________________________________________

Extra curricular activities you enjoy:

__________________________________________________________________________________

Additional remarks:

__________________________________________________________________________________

I assert that all information given is true to the best of my knowledge.

_____________________________________________________________________________

Signature Date

Interview Date: _____________________________

Comments:____________________________________________________________________

____________________________________________________________________________

Start Date_______________ Room number______________ Payrate________________

Interviewer: ___________________________________________________