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Employment Application

Full Name

Phone Number


City, State

Date of Birth

When is the best time to call you?

What would you do in the following situation: You are in a classroom helping a child tie their shoe. Behind you back you hear arguing. You turn around to see John holding a toy; and, Sally crying. What would you do and why?

To work in a Child care facility, you must pass a background check. Is there anything on your background that may come up? If so, please explain the situation.

In Order to do a Background check, please provide the following State Licensed Identification Number

What State was your Identification from:



Eye Color

Hair Color

City and State of Birth


Do you have children that would attend the child care center? Please give their names and date of birth

Email Address


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