Day School Job Application Form

Personal Information

Name*

First Last

Address*

Street Address City State ZIP Code

Phone*

Email*

Please give your last 5 years of employment to include any time as a fulltime student or unemployed*

Name/City/State	Phone	From / To	Position 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 lines

Upload Resume*

Date of Employment*

Date FBI Fingerprint Check Completed*

TB Test Date*

Name of High School/Home School*

Did you graduate?*

Yes
No

Graduation Date*

GED Date*

CPR Training Expiration Date

First Aid Training Expiration Date*

CPR Certification Upload*

Pre-Service Training (For Caregivers)

Select which applies to you*

I have previous child care experience or training (DOES NOT REQUIRE 24 HRS of PRE-SERVICE) OR
I do not have previous child care experience or training.

Before being counted in the child/caregiver ration, I received 8 hours of pre-service training in the following areas:*

Developmental stages of children
Positive guidance and discipline of children
Supervision and safety practices in the care of children
Preventing the spread of communicable disease
Age-appropriate activities for children
Fostering children's self-esteem
Positive interaction with children

Select all that apply

Select which applies to you*

I will not be working with children younger than 24 months. (DOES NOT REQUIRE THE TRAINING LISTED BELOW) OR
I will be working with children younger than 24 months.

Before being counted in the child/caregiver ratio for a group of children younger than 24 months of age, I received one hour of pre-service training in the areas listed below*

Recognizing and preventing shaken baby syndrome and abusive head trauma;
Understanding and using safe sleep practices and preventing sudden infant death syndrome (SIDS); and
Understanding early childhood brain development.

Attached Documents

Copy of photo identification*

Copy of current driver's license for persons transporting children in care

Not applicable if not transporting children

Staff Training Record (Form 7258)*

Educational Documentation

Signature

Applicant Signature*

First Last

By typing your name, you acknowledge that you are the person represented in this form and everything you have stated in this form is true and accurate.

Fill out the form below!

Personal Information

Pre-Service Training (For Caregivers)

Attached Documents

Signature