Application Form

EmPLOYMENT APPLICATION FORM

Application Form

Date of Application*

Social Security Number

Last Name*

First Name*

Middle Name

Address (Street Number & Name)

City

County

State

Zip Code

Mobile Phone or preferred*

Position Applied For

Date of Birth

N.C. Driver's License Number

Have you ever been convicted of breaking the law other than a minor traffic violation?

Yes

If yes, please mention the date and details

Have you ever had a Department of Social Services (DSS) Substantiation?

Yes

If yes, Please list the County / State , date and details

Free Text

(The Offense(s) and how recently you were convicted will be evaluated with the job you are applying for.)

EDUCATION

EDUCATION

Select the highest grade completed

GED

College

Schools

Schools

High School

Date Attended

Course of Study

Degree / Diploma

College or University

Date Attended

Course of Study

Degree / Diploma

Graduate or Professional

Name and Location

Date Attended

Degree / Diploma

Educational, Vocational Schools, etc.

Date Attended

Course of Study

Degree / Diploma

Child care are training you have completed in the last three years (such as first aid, CPR,CDA,ITS-SIDS, etc.) :

REFERENCES

REFERENCES

REFERENCES

List the names, addresses, and phone numbers of two people we may contact as references.

Name

Address

Phone Number

Name

Address

Phone Number

BLANK

Work History

WORK HISTORY

(List child care/early childhood experience first.)

Current or Last Employer

Address

Job Title

Supervisor's Name

No. supervised by you

Date Employed

Date Separated

Starting Salary

Ending Salary

May we contact employer?

Reason for leaving

Duties

Full Time

Years

Months

Fulltime

Months

If part time, number of hours per week

DIVIDER

Current or Last Employer

Address

Job Title

Supervisor's Name

No. Supervised by you

Date Employed

Date Separated

Starting Salary

Ending Salary

May we contact employer?

Reason for leaving

Duties

Full Time

Years

Months

Fulltime

Months

If part time, number of hours per week

Free Text

I certify that I have given true, accurate, and complete information on this form to the best of my knowledge. In the event of confirmation, verification is needed for the listed work experience. I authorize educational institutions, associations, registration and licensing boards, and others to furnish whatever details are available concerning my qualification. I authorize investigations of all statements made in the application and understand that false information of documentation of a failure to disclose relevant information may be grounds for rejection of my application, disciplinary action, or dismissal if I am employed, and (or) criminal action. I further understand that dismissal on unemployment shall be mandatory if fraudulent disclosures are given to meet position qualifications.

Divider

Signature off Applicant

Date

DIVIDER

Ladybug Learning Academy

2251 Stallings Rd.

Matthews, NC 28104

704-882-1465

Interview Questions

(Please answer these questions completely and to the best of your ability)

What skills ar techniques do you use to assure good working relationships with co- workers?

What does dependability mean to you? It we asked your previous employer or co- workers, how dependable would they say you are on a scale of 1-5?

How do you assure effective classroom discipline and behavior ma nagement? Describe techniques you've used.

Name three things that are important to you in your workplace?

Name 3 licensing rules/regulation that is important to you.

What curriculum have you used in the past to plan for children’s activities?

Join Us Today

Phone: 704-882-1465

Email: ladybugacademy17@gmail.com

Address: 2251 Stallings Road Matthews NC 28104