The Village Preschool & Early Education Center Employment Application

We are an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex, age, national origin, or disability.

Name:_____________________________________________ Date:_____________

Address:________________________________________________________________

Phone no.:__________________ D.O.B.:_____________ S.S.no._________________

In case of an emergency, who should we notify?: ________________________________

Phone no:_______________________________

Position Applied for:_______________________ Date Available:_________________

Salary Desired: __________________ Referred by: _____________________________

Please number each location in order of preference:

St. Bethlehem ________ Woodlawn __________ Pleasant View __________

Educational Background:(List diplomas, degrees, & certificates)

(Title of Diploma) (School/Institution) ( Dates )

________________________ __________________________ ______________

________________________ ___________________________ _______________

________________________ __________________________ _______________

Would you be willing to continue your education by enrolling in courses or other training programs that may be recommended? _________________________________________

Training received (workshops, conferences, and course work):

(Title) (Date) (Hours completed)

____________________________ _________________________ _______________________

____________________________ _________________________ _______________________

____________________________ _________________________ _______________________

Former Employers

Name_______________________________ Dates: _________ to __________

Address _______________________________ Salary upon leaving _________

Phone ______________ Duties ___________________________________________

Position _____________________ Supervisor’s Name_________________________

Reason for Leaving _____________________________________________________

Name_______________________________ Dates: _________ to __________

Address _______________________________ Salary upon leaving _________

Phone ______________ Duties ___________________________________________

Position _____________________ Supervisor’s Name_________________________

Reason for Leaving _____________________________________________________

Name_______________________________ Dates: _________ to __________

Address _______________________________ Salary upon leaving _________

Phone ______________ Duties ___________________________________________

Position _____________________ Supervisor’s Name_________________________

Reason for Leaving _____________________________________________________

References

Please list at least three persons, not related to you, whom you have known at least one year who could attest to your interaction with children.

(Name/Title) (Address) (Phone) (How long known)

______________________ _______________________________ ________________ _________

______________________ _______________________________ ________________ _________

______________________ _______________________________ ________________ __________

______________________ _______________________________ ________________ __________

Declarations

A. Have you ever been under investigation for neglect or abuse of children or any

sexual charges that were fully cleared?

__________ Yes _________ No

B. Have you ever been convicted of a felony including any involving a suspended

sentence?

__________ Yes _________ No

C. Have you ever been convicted of or pled guilty to any offense involving the

manufacture, sale, distribution, or possession of an illegal substance?

__________ Yes _________ No

D. If you answered yes to A, B, or C, describe the offense, where it occurred, and

when:__________________________________________________________

_______________________________________________________________

_______________________________________________________________

Physical record:

How would you describe your general health? __________________________________

_______________________________________________________________________

Have you any defects in hearing, vision, or speech? ______________________________

Have you ever been seriously injured?_________________________________________

Are there any physical or personal limitations on the type of work you can do with

children at the center, or that would affect the amount of time you can spend at work?

_______________________________________________________________________

Date of your last physical exam _____________________________________________

Would you object to being fingerprinted?______________________________________

Do you have a drivers license?_______________________________________________

Are you available for part time work?_________________________________________

Are you available for substitute work? ________________________________________

I am aware that a background study will be performed before I can be hired.

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal.

In the event of my employment with The Village Preschool I agree to comply with the rules and regulations governing my employment. In the event I should terminate my employment, I agree to file my resignation two weeks prior to the date it will be effective. I understand that the first three months of my employment are probationary and if my services have not proved satisfactory, my employment may be discontinued at any time without prejudice.

Applicant’s signature:_______________________________________ Date: _________

General Information

Describe your ideal job: ____________________________________________________

Why do you want to work in childcare?________________________________________

________________________________________________________________________

What is your philosophy of early childhood education? ___________________________

________________________________________________________________________

What is your philosophy of behavior guidance?__________________________________

________________________________________________________________________

What would you say are your goals for the next 1-5 years?_________________________

________________________________________________________________________

What would you say your goals are for the next 5-10 years?________________________
________________________________________________________________________

Your 5 best qualities are: ___________________________________________________

________________________________________________________________________

Is there something about yourself you would like to improve on?____________________

________________________________________________________________________

What age group do you prefer working with?___________________________________

Is there an age group you absolutely would not want to work for?___________________

Describe a positive experience with children, tell what happened and what you think you did to make it positive?____________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Describe a challenging experience in disciplining children. Tell what you did, and what the outcome was. If you think it could’ve been handled differently, tell what you would do, if you could deal with it again. __________________________________________

________________________________________________________________________________________________________________________________________________

Please feel free to add any other comments: ____________________________________

_______________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please mail or fax application to any of the three locations listed below: