ACADEMY OF ART AND LEARNING

Employment Application

INSTRUCTIONS: It is important that you fill out all sections of this application completely  and to the best of your ability.  Your application will be used as part of the hiring process and, therefore, should represent your best effort.

Current information

Position Applying For

Name

Address

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Telephone

E-mail

Availability

When will be you available to begin employment?

List the days and hours you are available to work

Desired Wage: $

/hour

(please give a real number, not "negotiable" etc)

Driver's License Information

License Number

Class

Expiration Date

Would you be willing to transport children by vehicle?

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Criminal History

Have you ever been convicted of a crime?

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If yes, please explain when, where and disposition of case.

References

Please do not list family relatives. We recommend listing persons such as coworkers, teachers, etc., who have knowledge of your qualifications for the position for which you are applying. DHS does require that we personally speak with each of your references, so we recommend that you let your references know to expect a call from us.

Name

Address

Phone

Name

Address

Phone

Name

Address

Phone

Education

Name and Address of School

High School

Undergraduate College

Other (Study)

Field of Study

Years of Study

Degree/Diploma

Certifications

Date of Completion

CPR/First Aid

Medication

Mandated Reporting

List any seminars, classes, or other education not listed above which may help qualify you for this position

Employment History

List below all past and present employers over the past 5 years, starting with your most recent employer.  Account for all periods of unemployment.  You must complete this section this section even if you are attaching a resume. 

 May we contact your current employer?

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Is this your current employer?

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Employer #1

Address

Phone

Start Date

Starting Pay: $

End Date

Ending Pay:   $

Job Title

Supervisor

Supervisor e-mail

Job Duties

Reason(s) for Leaving

Employer #2

Address

Phone

Supervisor

Supervisor e-mail

Start Date

End Date

Starting Pay: $

Ending Pay:   $

Job Title

Job Duties

Reason(s) for Leaving

Employer #3

Address

Phone

Supervisor

Supervisor e-mail

Start Date

End Date

Starting Pay:  $

Ending Pay:    $

Job Title

Job Duties

Reason(s) for Leaving

Employer #4

Address

Phone

Start Date

End Date

Starting Pay:  $

Ending Pay:    $

Job Title

Supervisor

Supervisor e-mail

Job Duties

Reason(s) for Leaving

Other Questions

1.  Do you have any personal responsibilities or problems that may affect your daily attendance?  If yes, please explain.

2. Please tell us about your experiences working with children & what ages:

3. Do you look at this job as being long-term or temporary?

4. Please tell us why you would like to work with children:

5. What do you like most about working in childcare?

6. What do you like least about working in childcare?

7. What is your favorite age of children to work with and why?

 8. Have you ever taught or assisted with teaching preschool (i.e. circle time, lessons from a curriculum)?  If so, please describe your      experience

9. In your past work experience, how many children have you cared for alone and what ages?

10. Briefly explain your philosophy on disciplining children.

11. Briefly explain your philosophy on educating children.

12. How would you respond to:

a. a child who is having a temper tantrum?

b. a child who will not nap (just standing in crib crying)?

c. a child who talks back to you?

d. a child who hits or bites you?

e. a child who continually disrupts circle time?

f. a child who is having trouble separating from parent at drop-off time (upset, crying, clinging, etc.)?

g. a child who is having difficulty learning a skill or concept?

13. Describe a time when you had to handle an emergency or injury with a child.

14. What elements do you think make up a quality daycare?

This job requires 20 clock hours of childcare-related training per year. Do you understand that you will be responsible for acquiring this training, that you are responsible for the costs (if any) of this training, and that the training must be completed on your own time?

Yes (initial)

Please read & initial the statement below.

I certify that, to the best of my knowledge & belief, the information given truly represents my background & experience. I understand that if I have knowingly misrepresented or falsified any of the application information I may be disqualified for employment consideration or dismissed from employment.

I authorize my current and former employers to give any information regarding my employment, together with any information regarding me whether or not it is on their records. I hereby release them from any damage whatsoever for issuing same. I also permit this employer to make a background investigation of me.

Initial and Date