Employment Application - Little Scholars Academy

Today's Date

Applying for:

Full-Time
Part-Time
Temporary

Position Applying for:

Date Available for Employment:

Your Full Name:*

Current Address:

Street Address City State / Province / Region ZIP / Postal Code

Contact & Other Information

Home Phone:

Cell Phone:*

Email:*

US Citizen:

Yes
No

Do you have a Social Security Number?*

Yes
No

Date of Birth:

Employment History

1) Current or Most Recent Employer:

Your Position:

How Long? From:

to:

Starting Wage:

Employer's Address:

Street Address City State / Province / Region ZIP / Postal Code

Employer's Phone:

Contact Person:

Reason for leaving or looking for other job:

2) Previous Employer:

Your Position:

How Long? From:

to:

Starting Wage:

Employer's Address:

Street Address City State / Province / Region ZIP / Postal Code

Employer's Phone:

Contact Person:

Reason for leaving or looking for other job:

3) Previous Employer:

Your Position:

How Long? From:

to:

Starting Wage:

Employer's Address:

Street Address City State / Province / Region ZIP / Postal Code

Employer's Phone:

Contact Person:

Reason for leaving or looking for other job:

Personal References (3)

(1) Name:

Phone:

Relationship:

How Long?

(2) Name:

Phone:

Relationship:

How Long?

(3) Name:

Phone:

How Long?

Relationship:

Education

Highest Grade Level Completed:

(High School)

(College)

1
2
3
4

Degree?

Tell me about all applicable education and classes completed.

Tell me about any experience you have working with children.

What ages of children are you most comfortable working with?

Are you trained in Pediatric CPR and 1st Aid?

Yes
No

Are you willing to participate in ongoing training?

Yes
No

(note: you will not be eligible for an interview without being enrolled in the registry)
PLEASE DO NOT LINK YOURSELF TO OUR CHILD CARE.

Registry Number:

Expires:

Have you ever been convicted of a crime?

Yes
No

If Yes, please explain:

Are you willing to take a urinalysis for drug testing?

Yes
No

Are you able to perform all the required functions of this position?

Yes
No

If No, please explain :

I have answered these application questions fully and honestly and would like to be considered for a position at Little Scholars Academy. You have my permission to check all references and verify all information given here. (Please fill-in your Full Name)

Signed:

Today's Date