I would like to apply for:Lead Teacher (full time)Teacher Assistant (full time)Teacher Assistant (part time)After School Personal Information Name * Address * Telephone Number(s) Cell * Home Are you over the age of 18? * Yes No If NOT, can you legally work here? * Yes No How did you learn of our organization? * Have you ever been convicted of a crime? * Yes No If YES, please explain: Employment History Name of Company/Business * Starting Date * Ending Date * Supervisor * Reason for leaving * Phone Number * Describe the work you did * Name of Company/Business Starting Date Ending Date Supervisor Reason for leaving Phone Number Describe the work you did Name of Company/Business Starting Date Ending Date Supervisor Reason for leaving Phone Number Describe the work you did Personal References Please list two individuals that are able to provide information on your character and/or qualifications for a position at Kid Kampus. Please do not list family members. Name * Position * Phone Number * Professional References Please list two individuals that are able to provide information on your character and/or qualifications for a position at Kid Kampus. Please do not list family members. Name * Position * Phone Number * Do you give permission to contact the employers listed above? * Yes No Education High School Name * Course of Study * Last Year Completed * Graduated? * Yes No Undergraduate School Name Course of Study Last Year Completed Graduated? Yes No Graduate School Name Course of Study Last Year Completed Graduated? Yes No Other Course of Study Last Year Completed Graduated? Yes No **Upon Hiring a Transcript and/or Diploma must be furnished to the Director** Certifications Please list any certifications you have received, along with the expiration date. (CPR, First Aid, etc) On the lines below please explain why you entered or wish to enter the field of Child Care and/or Education and what you feel you have to offer the children enrolled at Kid Kampus. Yes, I hereby confirm that all information provided on this application is true. I understand that the provision of false information is grounds for immediate dismissal. * Signature * Date *
