Job Application Form

Application for Employment

Personal Information

Full name:

Phone: (Cell)

Phone: (Home)

Street Address

City

Zip

E-mail Address:

Are you 19 years of age or order? Yes No

Education

High School:

Graduation date:

College/University:

Graduation date:

College/University:

Graduation date:

Other Education/Training:

Graduation date:

Company 1

Company Name:

Title Achieved:

Company Address:

Company Phone Number:

Name(s) of Manager(s)

Employment date started:

Employment date end:

Duties:

Salary/Wage You Received:

Reason(s) for leaving:

Company 2

Company Name:

Title Achieved:

Company Address

Company Phone Number:

Name(s) of Manager(s):

Employment start date:

Employment end date:

Duties:

Salary/Wage You Received:

Reasons 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 above?(college courses, professional trainings, etc.) If so, please list them here:

What salary do you wish to earn at PBECC?

Do you have authorization to work in the U.S.? Yes No

In addition to the managers listed above, please list references of individuals who can attest to your abilities, attitude, and character in childcare and/or early childhood education.

Reference 1

Name:

Phone:

Relationship:

Reference 2

Name:

Phone:

Relationship:

Reference 3

Name:

Phone:

Relationship:

Additional Questions

We are a congregation of the Lutheran Church - Missouri Synod(LCMS), and we teach our beliefs through this Center. Do you understand what the LCMS believes (or are at least 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? Yes No

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 you can physically, mentally, and emotionally handle these requirements? Yes No

Is there anything else you would like us to know about you?

Signature

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.

Signature of Applicant:

Date:

Security

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