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Cypress Daycare Application
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What is your full legal name?
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What is today's date?
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MM
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DD
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YYYY
Address (include city, state and zip)
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Phone Number
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Are you over 18?
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Yes
No-17
No-16
Church Membership
Your answer
Position Desired
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Part Time
Full Time
Are you a born again christian?
Yes
No
I'm not sure
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Who referred you?
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What is your desired salary?
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Education Background ( Please note if you graduated)
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List 3 References (Not Family Members) with their NAME, PHONE NUMBER, RELATION
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Please list up to 3 previous employers with phone numbers. Specify the time period you work there and your reason for leaving.
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List any previous church work involving children.
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Have you ever been convicted of or on probation for either sexual or physical abuse?
Yes
No
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Have you ever been treated for a psychiatric disorder?
Yes
No
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Write a short paragraph telling why you are interested in applying for a position here at Cypress Daycare and what do you think the expectation of you would be?
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Please write your full name as your signature.
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