Good Shepherd Lutheran
Last Name
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First Name
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Street Address
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City
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State
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Zip Code
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Phone Number
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Email Address
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Date of Birth
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Male/Female
Have you been convicted of a crime in the past?
If yes, please explain.
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Name & Location of High School
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Did you graduate?
Name & Location of Colleges Attended
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Did you graduate?
What was your major?
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List other training, certification, or licenses held. (for example: CPR)
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What is your related volunteer experience?
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How many years of childcare experience do you have?
Which age group would you prefer to work with?
Describe your experience in brief detail.
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Are you looking for full-time or part-time?
What is your availability?
Required
What is your desired rate of pay?
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What is the name, address, and phone number of your most recent employer?
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Start Date
MM
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DD
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YYYY
End Date
MM
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DD
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YYYY
Name and Title of Supervisor
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Ending rate of pay
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Reason for leaving?
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What were your job responsibilities?
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Name, Address, and Phone Number of Previous Employer?
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Start Date
MM
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DD
/
YYYY
End Date
MM
/
DD
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YYYY
Name and Title of Supervisor
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Ending rate of Pay
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Reason for leaving
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Describe Major Responsibilities:
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Reference #1 Name and Phone Number
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Reference #2 Name and Phone Number
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Reference #3 Name and Phone Number
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Before offered a position, you will be required to prove: 1. You have not been convicted of child abuse or child neglect. 2. You have not been convicted of a felony involving harm or threatened harm to an individual. Good Shepherd Early Childhood Center is a non-profit organization and does not provide unemployment pay. Do you agree with these statements?
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