Applicant |
First Name* |
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Last Name* |
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Last Four Digits of Social Security Number* |
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Email Address* |
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Present
Address |
Address* |
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City* |
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State* |
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Zip* |
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Telephone* |
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Permanent
Address
(if different) |
Address |
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City |
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State |
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Zip |
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Telephone |
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Employment
Eligibility |
Are you legally employable within the United States at the present time?* |
Yes
No
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General
Questions |
Have you ever applied
here before?* |
Yes
No
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If you answered
yes to the above question, please indicate last application date. |
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Were you ever employed by Doodle Bugs! in the past?* |
Yes
No
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If you answered
yes to the above question, please indicate which center and time period. |
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How were you referred
here?* |
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If referred by
friend/employee, please provide their name: |
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Have you ever held a child care license with the Department of Children and Families (or other state agency) or been registered to provide child care in your home?* |
Yes
No |
While employed in a child care program, have you ever been the subject of disciplinary action, or been the part responsible for a child care facility receiving an administrative fine or other disciplinary action?* |
Yes
No |
Desired
Employment |
Position Applying For* |
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If the above
position is not available, would you consider another position? If so, please
list. |
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Employment Type* |
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Salary Desired* |
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Location Desired* |
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Date Available To Start* |
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We are open Monday-Friday,
from 6:30am to 6:30pm. Please indicate the days and times which you are
available to work*: |
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Previous
Employers
Starting With Current or Most Recent |
Dates Employed |
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Company Name |
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Address |
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Telephone |
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Supervisor |
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May we contact your
Supervisor? |
Yes
No
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Duties |
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Beginning Salary |
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Ending Salary |
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Reason For Leaving |
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Other Employer |
Dates Employed |
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Company Name |
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Address |
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Telephone |
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Supervisor |
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May we contact your
Supervisor? |
Yes
No
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Duties |
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Beginning Salary |
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Ending Salary |
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Reason For Leaving |
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Other Employer |
Dates Employed |
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Company Name |
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Address |
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Telephone |
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Supervisor |
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May we contact your
Supervisor? |
Yes
No
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Duties |
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Beginning Salary |
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Ending Salary |
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Reason For Leaving |
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Previous
Unemployment
Starting With Most Recent Period |
Date Unemployment Began |
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Date Unemployment Ended |
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Reason for Unemployment |
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Other Period |
Date Unemployment Began |
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Date Unemployment Ended |
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Reason for Unemployment |
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Are you currently on
"layoff status" and subject to recall?* |
Yes
No
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Education
Background |
High School* |
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Did you Graduate?* |
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Major, if any |
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College/University/Technical School |
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Address |
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Did you graduate? |
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If still in college, which courses are you presently taking? |
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College Major, if any |
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College Minor, if any |
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Professional Licensure/Certifications (include CPR/First Aid) |
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Special Skills |
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Reference(Please list 3) |
Name* |
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Address* |
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Telephone* |
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Second Reference |
Name* |
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Address* |
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Telephone* |
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Third Reference |
Name* |
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Address* |
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Telephone* |
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Questionnaire
Please complete the following
sentences.
There are no right or wrong answers.
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Teachers needs....* |
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A child feels happy when....* |
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Children are wonderful and....* |
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In talking to parents, you should....* |
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Please answer the
following questions.
There are no right or wrong answers.
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What role should parents play in a child care program?* |
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How do you feel about parents who work and leave their children in daycare?* |
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About You
On a scale of 1 to 10,
please indicate
the level which best describes you. |
Are you conscious of your strengths and weaknesses?* |
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Never Sometimes Always |
Are you confident?* |
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1
2 3 4 5
6 7 8 9
10 |
Are you flexible in the workplace?* |
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Are you organized?* |
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Do you take responsibility for your own actions?* |
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Do you enjoy working with a team to get the job done?* |
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Do you maintain honesty & integrity in your life?* |
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Do you take initiative in your life?* |
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Do you try to anticipate parents' &
children's needs?* |
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Never Sometimes Always |
Do you communicate effectively?* |
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1
2 3 4 5
6 7 8 9
10 |
Can you problem solve without reacting emotionally?* |
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Do you remain positive in a negative situation?* |
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Do you guide & inspire others in the workplace?* |
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Are you creative?* |
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Are you dependable?* |
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Why do you want to
work for Doodle Bugs!? |
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