Elevate Preschool Programs & Fees

Employee Application

Application Date

Name:

First

Middle

Last

Maiden

Home Address/County:

Address City State Zip Country

Home Phone

Cell Phone

Email Address*

Date of Birth

Social Security Number

DL #: TX

CPR Certified

Yes
No

Food Handlers

Yes
No

Days desired

MWF
T TH
M-F

Desired Class Age Group

2yr old
3yr old
4yr
Any

Desired Salary ( per hour )

Do you require placement for a child(ren)?

Yes
No

Ages?

Last Five Years Previous Addresses:

Address

City

Country

State

Zip Code

Length

Address

City

Country

State

Zip Code

Length

Employment History:

Dates

Employer

Employer Phone #

Job Title

Description

Employment History:

Dates

Employer

Employer Phone #

Job Title

Description

Employment History:

Dates

Employer

Employer Phone #

Job Title

Description

Church/Volunteer History:
List other churches you have attended regularly during the past five years:

Dates

Employer/Church

Job Description

Education History: List name, years attended, certificate or degree obtained:

High School

College

Other

Criminal History:

Have you ever been arrested or convicted of any criminal offense?

Yes
No

Exclude the following situations:
1. Minor traffic violation for which the fine was less than $200
2. Any offense which was finally settled in juvenile court or under a welfare youth offender law.

Please explain

Is there any reason you should NOT work with or around children?

Yes
No

Have you ever been the subject of a child abuse investigation?

Yes
No

Please explain

Please Note- A QUALIFIED CANDIDATE MUST BE-
* Able to sit/ stand for prolonged periods of time
* Able to bend / stoop at a 45* angle
* Able to reach and pull
* Able to lift 50 lbs
* Able to lift 30 lbs over the head
* Possess visual acuity to determine the accuracy, neatness and thoroughness of the work assigned.
* Able to view a computer screen and various types of typing for long periods of time

Employee References

1. Name

Address

Phone Number

Relationship

2. Name

Address

Phone Number

Relationship

3. Name

Address

Phone Number

Relationship

Employment Application

Employee References

Contact