(Exclude those which may disclose your race, color, religion or national origin)
Have you ever been arrested, charged, or convicted of a criminal offense? Yes__, No__ If yes, give details. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Have you ever received treatment/counseling from a psychologist/psychiatrist/counselor? Yes__, No__ If yes, give details. _______________________________________________________________________________
List all courses, workshops and conferences related to child development, early childhood education, and administration/management of daycare centers. Attach additional pages if necessary.
Title of Course/Workshop Sponsor Date Location Hours
Write a short paragraph indicating why you applied for a position at Heritage Child Development Center, your understanding of this program, and what you think would be expected of you in this position.
Address___________________________________ Employed-State month & Year
Name of Supervisor__________________________ From________ To__________
Position____________________________________ Reason for Leaving__________
REFERENCES Name three unrelated persons whom we may contact as references. One should be a former employer or a teacher if not previously employed.
Did you serve in the U.S. Armed Forces? Yes No If “Yes”, which Branch? _________________________________________________________________
Describe any training received relevant to the position for which you are applying.
The information provided in this Application for Employment is true, correct, and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal. I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.