Applications

Position Applied For:*
Date of Application
MM slash DD slash YYYY
Name:*
Driver's License#:*
Address:*
City:*
State:*
Zip:*
Contact Phone:
Email Address:
Education and Formal Training
High School
Name & Location Course of Study # Credits Degree Date
College
Name & Location Course of Study # Credits Degree Date
Other
Name & Location Course of Study # Credits Degree Date
Please check all that apply:
- Early Child Credentials
- Administrative I & II
- DCDEE Qualification Letter
Other Certifications:
- ITS-SIDS
- CPR
- First Aid
- Professional Certification Level
Commercial Driver's License (CDL)
- Yes
- No
Do You Have Any Traffic Violations?
- Yes
- No
Are You Over 18?
- Yes
- No
Are You Over 21?
- Yes
- No
Have you applied with us before?
- Yes
- No
Date
MM slash DD slash YYYY
When could you begin?
MM slash DD slash YYYY
Availability:
- Full Time
- Part Time
- Substitute
Salary Desired $:
Hours Available
Monday Tuesday Wednesday Thursday Friday
Are you legally eligible for employment in this country?
- Yes
- No
Do you have any pending criminal arrests or charges, or have you had any prior criminal arrests?
- Yes
- No
Have you ever been convicted of other forms of child abuse, or of a violent felony?
- Yes
- No
Have you ever pled "guilty" or "no content" to, or been convicted of any crime?
- Yes
- No
Conviction Date:
MM slash DD slash YYYY
Conviction Details:
Conviction Details:
Answering "yes" to these questions does not constitute an automatic bar to employment. Factors such as state of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.
Are you willing to submit to a drug test?
- Yes
- No

Work Experience Pt.1
Please list your last three employers starting with the most recent. Attach additional sheets if necessary to show experience relevant to the position for which you are applying.
Date Start:
MM slash DD slash YYYY
Date End:
MM slash DD slash YYYY
Employer
Job Title:
Address
Supervisor & Title:
Phone Number:
May we contact for a reference?
Summarize the nature of work performed and job responsibilities:
Reason for leaving:
Part time/Fulltime Hourly rate/salary
Start: $ Per Final: $ Per

Work Experience Pt.2
Please list your last three employers starting with the most recent. Attach additional sheets if necessary to show experience relevant to the position for which you are applying.
Date Start:
MM slash DD slash YYYY
Date End:
MM slash DD slash YYYY
Employer
Job Title:
Address
Supervisor & Title:
Phone Number:
May we contact for a reference?
Summarize the nature of work performed and job responsibilities:
Reason for leaving:
Part time/Fulltime Hourly rate/salary
Start: $ Per Final: $ Per

Work Experience Pt.3
Please list your last three employers starting with the most recent. Attach additional sheets if necessary to show experience relevant to the position for which you are applying.
Date Start:
MM slash DD slash YYYY
Date End:
MM slash DD slash YYYY
Employer
Job Title:
Address
Supervisor & Title:
Phone Number:
May we contact for a reference?
Summarize the nature of work performed and job responsibilities:
Reason for leaving:
Part time/Fulltime Hourly rate/salary
Start: $ Per Final: $ Per

Professional References:
Please provide at least 2 references.
Name Position & Company Phone Number

Certification and Signature
I understand that any oral or written statement that is false, fraudulent or misleading that is contained in this application or attached materials or made in the course of any related employment process, whether made by me or by other at my request, will result in rejection of my application and possibly prosecution for a crime. I further understand that I must prove that I am authorized to work in the United States if I am hired. I authorize Children's World Learning Center to verify the employment and education information provided on this application.
Confirm*
- Yes
- No
Name
Date
MM slash DD slash YYYY

Children’s World Learning Center

Application for Employment

Application

Step 1 of 6

Education and Formal Training

Hours Available

Work Experience Pt.1

Work Experience Pt.2

Work Experience Pt.3

Professional References:

Certification and Signature

Name & Location	Course of Study	# Credits	Degree	Date

Name & Location	Course of Study	# Credits	Degree	Date

Name & Location	Course of Study	# Credits	Degree	Date

Monday	Tuesday	Wednesday	Thursday	Friday