Employment Application

Personal Information

Name(Required)

First Last

Home Phone

Cell Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Thank you for choosing Mary Elizabeth Day Care in your career path. We are dedicated to hiring professionals who are energetic, motivated, and possess integrity. Mary Elizabeth Day Care is an Equal Opportunity Employer. Applicants must show they understand and are able to meet the following requirements for employment by "checking" each item below.(Required)

Select exactly 9 choices.

High School Graduate or G.E.D recipient

Negative TB Test and will provide current medical documentation

United States Citizen, or legally authorized to work in the United States

Will provide Social Security Card or Birth Certificate

Will submit to drug and alcohol testing as required

Will complete an FBI criminal background check

Will complete a Child Abuse Registry check

Physically able to safely supervise young children and perform necessary job functions

Will maintain professional appearance and conduct at all times

General Information

Employment Desired(Required)

Full-time only

Part time only

Full or Part time

On Call

Position Desired(Required)

Hourly Rate Desired(Required)

Hours Available(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

Are you seeking temporary or permanent work?(Required)

Temporary

Permanent

Personal References

3 Personal References(Required)

(do not list family or previous employers)

Name

Address

Phone Number

Relationship (ie. Coworker, friend)

Educational Experience

High School(Required)

Name

Address

Year Graduated

College

Name

Degree or # Years Completed

Major

Child Development Associate Certification

List courses completed or relevant childcare training (CPR, First Aid, Child Development, etc.)

List other skills, vocational, and technical training

Employment History

Begin with most recent

Previous Jobs

Begin/End Date

Begin/End Salary

Employer/Address

Supervisor’s Name & Ph:

Your title and duties

Reason for leaving

Offenses

Criminal background checks will be conducted on all applicants

Have you ever pled guilty, no contest or been convicted of any criminal offense?(Required)

No

Yes

If yes, explain:(Required)

Has a report of child maltreatment ever been made against you?(Required)

No

Yes

If yes, explain:(Required)

Has a court ever denied parental, custodial, or visitation rights as a result of neglect or abuse of a child?(Required)

No

Yes

If yes, explain:(Required)

While employed in a childcare program, have you ever been the subject of disciplinary action or been responsible for a child care facility receiving an administrative or disciplinary action?(Required)

No

Yes

If yes, explain:(Required)

Personal Statement

Please write a brief statement as to why you would like to work here and what qualities you would bring to this job:(Required)

An application form sometimes makes it difficult to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

Type Name of Applicant(Required)

Date(Required)