PBECC Job Application All forms are required. If not applicable, then put N/A. Name * First Name Last Name Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Are you 16 years of age or older? * Yes No Are you 19 years of age or older? * Yes No High School * High School Graduation Date MM DD YYYY Post-Secondary Education * Please list all post-secondary education completed in a university or similar setting. Post-Secondary Education Graduation Date MM DD YYYY Other Education/Training * Other Education Completion Date MM DD YYYY Previous Employment Company Name * Title Achieved * Company Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Company Phone * (###) ### #### Name of Manager(s) * Start Date * MM DD YYYY End Date * MM DD YYYY Salary/Wage You Received Reason(s) for Leaving Additional Previous Employment Company Name * Title Achieved * Company Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Company Phone * (###) ### #### Name of Manager(s) * Start Date * MM DD YYYY End Date * MM DD YYYY Salary/Wage You Received Reason(s) for Leaving Additional Experience If not listed above, please list all experiences with childcare and/or early childhood education, including starting and ending dates. Do you have any additional childcare and/or early childhood education qualifications other than listed above? If so, please list them here. For example: college courses, professional trainings, etc.) What salary do you wish to earn at PBECC? * Do you have authorization to work in the US? * Yes No In addition to the managers listed above, please list references who can attest to your abilities, attitude, and childcare and/or early childhood education. Reference 1 * First Name Last Name Phone * (###) ### #### Relationship to Applicant * Reference 2 * First Name Last Name Phone * (###) ### #### Relationship to Applicant * Reference 3 * First Name Last Name Phone * (###) ### #### Relationship to Applicant * Additional Questions Are you baptized? * Yes No If so, on what date could we celebrate it? MM DD YYYY We are a congregation of the Lutheran Church-Missouri Synod (LCMS), and we teach our beliefs through PBECC. Do you undestand what the LCMS believes (or at least are willing to learn them), are you willing to teach them to the students, and will you model these beliefs to the children, the parents and the staff? (select all that apply) * I don't know what I believe about God (agnostic) I do not believe there is a God (atheist) I believe there is a Higher Power, but I don't know beyond that I believe in God, but not necessarily the one described in the Bible I believe in the Triune God - Father, Son and Holy Spirit I believe that Jesus is the Son of God, and that only through Him can a person be saved and have eternal life This is a full-time, early childhood center. During those times that you work directly with children, you will be expected to interest, teach, and disciple the children. Do you believe that you can physically, mentally, and emotionally handle these requirements? * Yes No Is there anything else you would like us to know about you? Signature By typing your name here, you are agreeing to this statement: This information is accurate to the best of my knowledge. I understand that Peaceful Beginnings Early Childhood Center will run a background check on me in the event that I am hired, and that employment is contingent on the status of my background check. Thank you for your interest in working at PBECC!
