NAME______________________________________     

ADDRESS___________________________________

CITY,STATE,ZIP____________________________

Email Address ____________________________

PHONE_____________________________________

SOCIAL SECURITY NUMBER____________________

 

PLEASE PRINT

 

DATE OF APPLICATION:  _____________________

 

POSITION APPLYING FOR: (please circle)

 

Teacher Aid: high school diploma required

Lead Teacher: 30 college credits with 6 ECE hours plus one year experience, 

                 or 60 college credits w/6 ECE hours and no experience, or CDA

Director: CDA and 12 ECE hours or 60 credits w/18 ECE hours

Other:___________________________________________________

 

  1. How did you hear about us? ________________________________

 

  1. When is the best time to call you? _________________________

 

  1. Are you legally eligible for employment? YES   NO

 

  1. Date you would be available to work ____/____/_____

 

  1. Type of employment desired: (please circle)

 

full time, part time, seasonal, temporary

 

  1. Will you work overtime if necessary?  YES    NO

 

  1. Have you worked with children before? YES    NO

 

  1. Have you ever been convicted of a felony? YES    NO

 

If yes, please explain:_____________________________________

 

____________________________________________________________

 

Please indicate below the hours you would be available to work on the following days.

Please note we are open from 6:30am to 6:30pm Monday through Friday.

 

MONDAY    FROM___________  TO___________

TUESDAY   FROM___________  TO___________

WEDNESDAY FROM___________  TO___________

THURSDAY  FROM___________  TO___________

FRIDAY    FROM___________  TO___________

 

WORK EXPERIENCE

 

PLEASE COMPLETE THE SECTION BELOW FOR THE LAST THREE PLACES YOU WERE EMPLOYED STARTING WITH THE MOST RECENT FIRST:

 

PLACE OF EMPLOYMENT_____________________________

ADDRESS_________________________________________

CITY, STATE, ZIP________________________________

TELEPHONE_______________________________________

DATES YOUR WERE EMPLOYED?  FROM___________ TO_____________

HOURLY RATE/SALARY (STARTING)_______________

HOURLY RATE/SALARY (ENDING)_________________

MAY WE CONTACT THIS EMPLOYER FOR A REFERENCE?  YES  NO  LATER

SUPERVISOR NAME ____________________  TITLE _________________

WHY DID YOU LEAVE THERE? ____________________________________

SUMMARIZE THE WORK PERFORMED AND JOB RESPONSIBILITIES

 

 

 

 

 

PLACE OF EMPLOYMENT_____________________________

ADDRESS_________________________________________

CITY, STATE, ZIP________________________________

TELEPHONE_______________________________________

DATES YOUR WERE EMPLOYED?  FROM___________ TO_____________

HOURLY RATE/SALARY (STARTING)_______________

HOURLY RATE/SALARY (ENDING)_________________

MAY WE CONTACT THIS EMPLOYER FOR A REFERENCE?  YES  NO  LATER

SUPERVISOR NAME ____________________  TITLE _________________

WHY DID YOU LEAVE THERE? ____________________________________

SUMMARIZE THE WORK PERFORMED AND JOB RESPONSIBILITIES

 

 

 

 

 

 

PLACE OF EMPLOYMENT_____________________________

ADDRESS_________________________________________

CITY, STATE, ZIP________________________________

TELEPHONE_______________________________________

DATES YOUR WERE EMPLOYED?  FROM___________ TO_____________

HOURLY RATE/SALARY (STARTING)_______________

HOURLY RATE/SALARY (ENDING)_________________

MAY WE CONTACT THIS EMPLOYER FOR A REFERENCE?  YES  NO  LATER

SUPERVISOR NAME ____________________  TITLE _________________

WHY DID YOU LEAVE THERE? ____________________________________

SUMMARIZE THE WORK PERFORMED AND JOB RESPONSIBILITIES

 

 

EDUCATIONAL BACKGROUND

 

 

HIGH SCHOOL ATTENDED_________________________

CURRENT GRADE LEVEL  9 10 11 12

DID YOU RECEIVE YOUR DIPLOMA?  YES   NO

GRADE POINT AVERAGE _____________

 

 

 

COLLEGE ATTENDED_________________________________

CURRENT LEVEL  1  2  3  4

DID YOU RECEIVE YOU DIPLOMA?  YES   NO

GRADE POINT AVERAGE _____________

MAJOR____________________ MINOR_______________________

 

PLEASE LIST ANY AND ALL EXTRACURRICULAR ACTIVITIES AND/OR AWARDS THAT YOU RECEIVED OR PARTICIPATED IN. (EXAMPLE: SPORTS, DRAMA, STUDENT GOVERNMENT)

 

 

 

 

 

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

REFERENCES

 

LIST NAME AND TELEPHONE NUMBER OF FOUR REFERENCES

 

NAME__________________________ NAME__________________________

TELEPHONE_____________________ TELEPHONE_____________________

YEARS KNOWN___________________ YEARS KNOWN___________________

RELATIONSHIP__________________ RELATIONSHIP__________________

 

 

NAME__________________________ NAME__________________________

TELEPHONE_____________________ TELEPHONE_____________________

YEARS KNOWN___________________ YEARS KNOWN___________________

RELATIONSHIP__________________ RELATIONSHIP__________________

 

 

 

Please fax completed application to (847)925-9845, email jamesourth@safarichildcare.com or mail to:

 

Safari Childcare, Inc. 

Attention: Hiring

126 E. Wing Street, Suite 336

Arlington Heights, IL 60004