Employment Application

First Name:*
Last Name:*
Phone Number:*
E-mail Address:*
High School Graduation Date:*
College Graduation Date:
College Degree:
Do you have a current background clearance letter?*
Do you have record of a negative TB test result that is less than a year old?*
Are you ITS/SIDS certified?*
Do you have an NC Early Childhood Credential or equivalent?*
Please list any additional certifications or education you have for child care:
Please describe your experience in child care:*
Please describe your career goals:*
Are there any physical limitations on the type of work you can do with children (i.e. sitting, lifting, etc)? If yes, please explain:*
Previous Employer:*
Previous Employer Phone:*
Position:*
Ending Hourly Wage:*
Reason for leaving:*
Previous Employer:*
Previous Employer Phone:*
Position:*
Ending Hourly Wage:*
Reason for leaving:*
Select the age groups with which you would like to work:*
 Infants
 Toddlers
 Two Year-Olds
 Three Year-Olds
 Four Year-Olds
Select the days you are available to work:*
 Monday
 Tuesday
 Wednesday
 Thursday
 Friday
Select the type of employment you are seeking:*
 Full Time
 Part Time
Are you interested in working as an on-call substitute teacher?*
 Yes
 No
Explain why you are the right person to hire as a child care provider:*
Paste your Linkedin page link here:
Paste your Facebook page link here:


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