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Full Name*

Address*

Email*

Phone*

Position

Start Date

Month

Day

Year

Please check each box. Applicants must show they understand and are able to meet the following requirements:*

High School Diploma or GED

US Citizen or legally authorized to work in US

Will provide Social Security Card or Birth Certificate

Will submit to drug and alcohol testing as required

Will complete a Childcare Criminal Background Check

Physically able to supervise and care for young children/preform job duties

Maintain professional appearance & conduct at all times

Childcare Experience

Please list any experience you may have. *

Babysitting

Early Childcare Center

Teaching

No Experience

List three personal references names and phone numbers. Please do not list family or previous employers.

Reference #1

Reference #2

Reference #3

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