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Employment Application
Employment Application
Basic Information
Name
*
Name
First Name
First Name
Middle Name
Middle Name
Last Name
Last Name
Date of Birth
*
Cell Phone
*
Email
*
Street Address
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City
*
State
*
Zip Code
*
Are You At Least 18 Years Old?
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-- Please Choose --
Yes
No
Are You Presently Employed
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-- Please Choose --
Yes
No
Do You Have a Driver's License?
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-- Please Choose --
Yes
No
Driver License / State ID Number
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Criminal History
Have You Ever Been Convicted Of Any Crime, Other Than Traffic Tickets?
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-- Please Choose --
Yes
No
Please Explain.
*
Have You Ever Been Convicted of a Felony Crime?
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-- Please Choose --
Yes
No
Please Explain Your Felony.
*
Emergency Contact
Please supply two, within a 45 minute radius of Sioux Falls
Name
*
Name
First Name
First Name
Last Name
Last Name
Phone
*
Relationship
*
Name
*
Name
First Name
First Name
Last Name
Last Name
Phone
*
Relationship
*
Employment Information
Employment Desired
*
-- Please Choose --
Full-Time
Part-Time
Seasonal Employment
What Postion Are You Applying For?
*
-- Please Choose --
Lead Teacher
Assistant Teacher
Teen Student Aid
Cook
Preferred Age Group
*
-- Please Choose --
Infants/Mobile Infants
One Year Olds
Two Year Olds
Potty Trainers
Preschool (3-5 Years)
School Age
Date Available To Start Working
*
How Did You Hear About Us?
*
-- Please Choose --
Job Search Website (Indeed, Etc.)
Online Search
Friend Or Family
Drove By Learning Center
Other
Hours On Monday (Check all that apply!)
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6 AM - Noon
8 AM - 2 PM
10 AM - 4 PM
Noon - 6 PM
After School - Close
Hours On Tuesday (Check all that apply!)
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6 AM - Noon
8 AM - 2 PM
10 AM - 4 PM
Noon - 6 PM
After School - Close
Hours On Wednesday (Check all that apply!)
*
6 AM - Noon
8 AM - 2 PM
10 AM - 4 PM
Noon - 6 PM
After School - Close
Hours On Thursday (Check all that apply!)
*
6 AM - Noon
8 AM - 2 PM
10 AM - 4 PM
Noon - 6 PM
After School - Close
Hours On Friday (Check all that apply!)
*
6 AM - Noon
8 AM - 2 PM
10 AM - 4 PM
Noon - 6 PM
After School - Close
What Obligations Do You Have During The Week That Need To Be Considered For Scheduling?
Have You Ever Applied For Employment Or Been Employed at LifeChange Learning Center?
*
-- Please Choose --
Yes
No
Do You Have Any Relatives or Friends Working At LifeChange Learning Center?
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-- Please Choose --
Yes
No
If Yes, What Are Their Names?
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Education History
Name of Middle School Or High School
*
Activities Involved In
*
Grade Completed
*
Dates Attended (Year - Year)
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College or Trade School #1
Major/Specialization #1
Level or Degree Completed #1
Dates Attended #1 (Year - Year)
College or Trade School #2
Major/Specialization #2
Level or Degree Completed #2
Dates Attended #2 (Year - Year)
Please List Any Additional Experience, Schooling, Qualifications, or Training:
Employment History
Start with your present or most current position and work backwards. If you were ever employed in any position under a different name, for each position give the name used.
Have You Ever Served In Any Branch of the United States Armed Forces?
-- Please Choose --
Yes
No
Which Branch and When?
*
Are You Currently On Layoff Status, Leave of Absence Or Other Suspension Of Employment And Subject To Recall With Another Employer?
*
-- Please Choose --
Yes
No
Please Explain.
*
Company #1
Company Name
*
Dates of Employment
*
Street Address
Position
*
City
*
Supervisors Name
*
State
*
Zip Code
*
Supervisor's Phone or Email
*
Job Duties
*
Reason For Leaving
*
Company #2
Company Name
Dates of Employment
Street Address
Position
City
Supervisor's Name
State
Zip Code
Supervisor's Phone or Email
Job Duties
Reason For Leaving
Company #3
Company Name
Dates of Employment
Street Address
Position
City
Supervisor's Name
State
Zip Code
Supervisor's Phone or Email
Job Duties
Reason For Leaving
References
List three (3) persons not related to you, and who can furnish information about you. Do not repeat names of supervisors furnished in the employment record.
Reference 1
*
Reference 1
First Name
First Name
Last Name
Last Name
Reference Relationship 1
*
Reference Phone 1
*
Reference Email 1
Reference 2
*
Reference 2
First Name
First Name
Last Name
Last Name
Reference Relationship 2
*
Reference Phone 2
*
Reference Email 2
Reference 3
*
Reference 3
First Name
First Name
Last Name
Last Name
Reference Relationship 3
*
Reference Phone 3
*
Reference Email 3
Christian Standards
LifeChange Learning Center is a Christian based DayCare and Preschool. As such, we use Bible Based curriculum, and hold our employees to a Christian standard. These questions below will assist us in determining whether or not you are a good fit with our team.
Please Give Your Christian Testimony (Story).
Do You Believe The Bible To Be The Only Inspired And Infallible Word of God, Our Final Authority In All Matters Of Faith, Truth, And Conduct?
-- Please Choose --
Yes
No
I Have No Reservations When It Comes To Teaching And Implementing Christian Based Curriculum.
-- Please Choose --
Yes, I agree.
No, I Do Not Agree.
If you do not agree, please explain.
*
What Do You Consider To Be A Healthy Childcare Atmosphere?
Drug Policy
LifeChange Learning Center does not hire persons who use illegal drugs. Persons hired may be required to take and pass a strict screen for illegal drugs and may be subject to periodic tests for illegal drugs. LifeChange Learning Center has a strict no smoking policy, which includes in the parking lots, buses, and vans.
I Certify That I Do Not Use Illegal Drugs.
*
Yes, I Agree.
No, I Do Not Agree.
Agreement & Certification
I hereby certify that the facts set forth in this application (and accompanying resume) are true and complete to the best of my knowledge. I agree and understand that any misrepresentation of information or failure to disclose information during the employment process may disqualify me from further consideration for employment and if employed, will subject me to dismissal. If I am released under these circumstances, I further understand and agree that I will be paid and/or receive benefits only through the day of release. I understand that I must submit an Abuse and Neglect screening through the state of South Dakota Division of criminal Investigation and other state and federal authorities. I understand and agree that any offer of employment that I may receive from the center is conditioned upon the receipt of background information, including criminal background information. If employed, I agree to conform to all LifeChange Learning Center rules and regulations and Federal, State and local rules and regulations. In this regard, I understand that LifeChange Learning Center may, at its discretion, conduct searches of lockers, lunch boxes, tool boxes, clothing, purses, briefcases, vehicles, desks, work areas and other personal or LifeChange Learning Center property, and I hereby consent to such search. I also understand that if employed, my employment is for an indefinite period of time, that either LifeChange Learning Center or I may terminate my employment at will at any time, with or without cause or notice.
Consent
*
I Attest That The Answers Above Are True To The Best Of My Knowledge.
Signature
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