Twin Pines Apartments at Shirley Hills

Employment Application

Sandy’s Sandbox Child Care & Learning Center, Inc.

"Let Them Be Little"

 

Applicant's Name

      

                            (first)                                    (middle)                                             (last)

Spouse's Name, if applicable

      

                            (first)                            (middle)                                            (last)

Home Address (street)

                        (city, state)

                        (zip)

 

Daytime phone number                             --

Evening phone number                             --

 

Email Address

Social Security Number  

Date of Birth              

                        (month)            (day)           (year)

 

Position Applied for                                 

 

I am applying for a position at the   location

 

Desired Salary                                      

 

Earliest Available Start Date             

                                               (month)            (day)           (year)

 

Do you have a valid Drivers License?   Yes            No

        If yes, provide state of issuance

                           and license number

                               and license class

 

What type of employment are you seeking?    

If you are under the age of 18 can you submit a work permit?             Yes   No    NA

If you are not a US citizen do you have a Visa to work in the US?       Yes   No   NA

        If yes:

        What is your Visa classification

        Visa Registration Number

        Visa Expiration Date                           

                                              (month)                        (day)                               (year)

 

Have you ever had a bond or security clearance denied and/or canceled?     Yes    No

        If yes, please explain.

                   

 

Education

(please be prepared to provide validation of all education)

                            Location                                  Date of Graduation               Diploma/Certificate/Degree                        

Elementary                             

High School                              

Undergraduate                       

Graduate                                   

Other                                     

 

 

Have you completed any child care training courses?       Yes    No

        If yes, provide details.

               

 

Have you had CPR training in the past two years?       Yes    No

        If yes, give the expiration date.                     

                                                       (month)                       (day)                              (year)

 

Have you had first aid training in the past three years?       Yes            No

        If yes, give the expiration date.                    

                                                       (month)                       (day)                            (year)

 

Do you have a criminal record? Yes     No

       If yes, provide details.

               

 

Have you ever been shown by credible evidence, e.g. a court order or jury, a department investigation or other reliable evidence to have abused, neglected or deprived a child or adult or to have subjected any person to serious injury as a result of intentional or grossly negligent misconduct?  Yes            No

Under the American with Disabilities Act of 1991, this program is required to reasonable accommodate
individuals with a disability. The reasonable accommodation requirement applies to the application process,
any pre-employment testing, interviews and actual employment, but only if the program supervisor is made
aware that an accommodation is required. If you are disabled and require accommodation, you may
request it at any time during the interview process. You are obligated to inform the program director of
your needs if it will impact your ability to perform the job for which you are applying.
Having read the job description for the position which you are applying, are you in all respects, able to
adequately perform the duties as described?  Yes    No

       If no, provide details.

               

 

Bright From the Start, Georgia Department of Early Care and Learning requires annual child care training,
are you willing to participate?   Yes    No

 

Please list employment history for the past ten years, beginning with your most current employer. If you have been unemployed at any time during the past ten years list how you spent your time, e.g. student, home maker, unemployed etc...

Month/Year

Name and Address of Employer Job Title

From: 

    To:

   

From:

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From:

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From:

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From:

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From:

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From:

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From:

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From:

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From:

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Please list any experience with groups of children.

 (Indicate ages of children, your duties, dates of time you worked in this position, reasons for leaving)

 

I understand if a job offer is made to me, a satisfactory criminal background will be required prior to my first
day of employment.  Yes     No

 

I certify that all the information on this application is correct. I have not given any false statement concerning
my qualification requirements. Yes      No
 

SSCC&LC, Inc.