Day School Job Application Form Fill out the form below! Basic Information*Required fields are indicated with a red asterisk. Please fill in all required fields. Failure to fill in all required fields will result in your form not being submitted.Name* First Middle Last Maiden Name If ApplicableYour SSN* Your Phone*Your Email* Driver's License UploadAccepted file types: jpg, png, pdf, Max. file size: 15 MB.Allowed File Types are jpg, png, pdfMax File Size: 15MBIf you are having issues uploading the file here, submit a copy of your drivers license to staffcoordinator@alighthouseforkids.comIf you are CPR certified please upload documentation here.Accepted file types: jpg, png, pdf, Max. file size: 15 MB.Allowed File Types are jpg, png, pdfMax File Size: 15MBIf you are having issues uploading the file here, submit a copy of your drivers license to staffcoordinator@alighthouseforkids.comAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your Date of Birth* MM slash DD slash YYYY Other States Lived in:* If you have not lived in any other state, type NONE.Click the (+) for additional lines.Other Alias Names used:* If you have never used another name, type NONE.Click the (+) for additional lines.Please give your last 5 years of employment to include any time as a fulltime student or unemployed*Name/City/StatePhoneFrom / ToPosition Held Example: ABC Day Care / Beaumont / TX -- 325-642-1234 -- Jan. 2016 to present -- childcare worker Sherman High School / Sherman / TX -- 903-642-1234 -- Aug. 2012 / May 2016 -- Full time student Click the (+) for additional linesPlease add three references that are not relatives.*Their NameTheir PhoneHow you know themHow long you have known them Such as Friends, Pastors, or SupervisorsDo you have any prior criminal arrests and/or convictions to include any traffic citation for child safety issues* Yes No If so, please give the date(s) of the offenses, nature of the offenses, and any other pertinent information.*Authorization SectionBy agreeing below, I do hereby give permission to A Lighthouse For Kids to run a background check for the purpose of working on the government contract for the military. I understand that this is a requirement by the military to be able to work on the contract performing childcare. I understand that everyone is required to have this done BEFORE they can work.* Agree Disagree Name* First Middle Initial Last I affirm that the person filling out this form is the person listed above.* Agree Disagree Δ
