Employment Application

    APPLICANT INFORMATION

    First Name (required)

    Middle Initial

    Last Name (required)

    Street Address

    City

    State

    Zip Code

    Your Phone (required)

    Social Security No.

    If no, are you authorized to work in the U.S.?
    yesno

    Your Email (required)

    Alternate Contact Name

    Alternate Phone (required)

    Position Applied for

    Desired Hourly Rate

    Hours Desired

    Date You Can Start?

    EDUCATION

    High School Name

    High School Address

    Dates attended

    Did you graduate?
    yesno


    Name of College(s) Attended

    What Did You Major/Minor in?

    When Did You Graduate?

    Degree Held

    What is Your Future Plan for Additional Education?

    Do You Have Any(other) Certifiations in Early Childhood Classes?

    Are You CPR and First Aid Certified?
    yesno

    Do You Speak, Read and Write any Other Languages Other Than English?
    yesno

    If Yes, Which Languages?

    Katy's ECEC Required That Lead Teachers to Hold a Minimum of a Child Development Associate's Certificate(CDA). Do you Hold That Certificate?
    yesno

    Are You Willing to Pursue a CDA?
    yesno

    Why do You Belive You Are Qualified For a Position in Early childhood? Explain.

    PREVIOUS EMPLOYMENT

    Last Employed By

    Phone No.

    Dates Employed

    Supervisor Name

    Reason for Leaving


    Employed By

    Phone No.

    Dates Employed

    Supervisor Name

    Reason for Leaving


    Employed By

    Phone No.

    Dates Employed

    Supervisor Name

    Reason for Leaving


    May we Contact These Employers?
    yesno

    If no, Please Explain:

    PERSONAL REFERENCES

    Please list personal references by Name, Phone Number, Relationship, and Years Known:

    1.

    2.

    3.

    PROFESSIONAL REFERENCES

    Please list professional references by Name, Address, Phone Number, and Years Known:

    1.

    2.

    3.

    What is Today's Date?