LIL’ PEOPLE DAYCARE CENTER, INC.
EMPLOYMENT APPLICATION FORM
Name________________________________________________ Soc. Sec#_______________________ Date_____________
First
Middle Last Maiden
Address________________________________________
City/ State_____________________ Zip______________________
Phone__________________________ Place
of Birth__________________________ Age____________ DOB_____________
Marital Status _______________________ Spouse’s Name ______________________________________________________
Occupation __________________________ Firm ____________________________ Age ___________ Phone_____________
Children (name &
age) ____________________________________________________________________________________
Emergency Contact
Person _________________________________________ Relationship ____________________________
Address of contact___________________________________________________ Phone______________________________
EDUCATION
High School ________________________________________________________________
Yr. Graduated ________________
College ___________________________________Major_______________________________
Yr Graduated _____________
Major Areas ___________________________________________________
Degrees Earned ____________________________
Do you have a Child
Care Worker Certification/ Degree? ______________ DateEarned______________________________
Do you have any American
Red Cross Card ?___________________________________________________________________
Do you have a Food
Service Certification? ____________________________________________________________________
What Educational
Workshops have you attended? _______________________________________________________________
Other Certificates
and Honors:______________________________________________________________________________
PREVIOUS TEACHING OR COUNSELING EXPERIENCE
Sunday School (Age
or Group) ______________________________________________________________________________
Summer Camp ___________________________________________________________________________________________
Scouts _________________________________________________________________________________________________
Big Brother / Big
Sister ____________________________________________________________________________________
Other activities
planned for children __________________________________________________________________________
What age group have
you worked with the most? ________________________________________________________________
What age group do
you like the most? _________________________________________________________________________
What art/ crafts
experience do you have? ______________________________________________________________________
What music experience do you have? _________________________________________________________________________
Do you play an instrument?
_________________________________________________________________________________
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PEVIOUS EMPLOYMENT:
Firm/Address
Position______________from/to_______________Supervisor___________Phone_________
_______________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Do you have a Driver’s License?____________________________________License # ________________________________
Do you have a chauffeur’s
License? __________________________________License # ________________________________
Do you have Insurance? ___________________________________________________________________________________
Why do you like to
work with children? _______________________________________________________________________
Date available to
start work ___________________________ What hours do you like the best? __________________________
Full time ______________
Part time _________________ School Year __________________ Summers ___________________
REFERENCES
People that have
observed you working with children:
Name_________________________________Relationship_________________Address________________Phone___________
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
You have my permission to check the
references listed above. You also may do a State background check. I also agree to complete the required yearly in-service hours that are necessary to work in Daycare.
Date:
Applicant’s Signature:
FOR OFFICE USE ONLY
Was applicant hired?_________________
Date began _______________Position _____________________________________
Date__________________Terminated________________
Comments________________________________________________________________________________________
_______________________________________________________________________________________________________
