Home Phone #
Birth Date: (MM/DD/YYYY)
Social Security #
Hourly Rate Desired:
Date Available To Start:
Employer's Phone #
Drivers License #
Are you 16 or older?
Are you 19 or older?
Date of Last Physical:
Date of Last T.B. Test
Do you have any physical or mental health issues that would put children in your care at risk?
Have you ever been convicted of child abuse, unlawful sexual behavior, or a felony of any kind?
Do we have your permission to verify your work experience and qualifications?
High School Name/Address:
How Many College Credits In:
Child Growth & Development?
Creative Activities for Preschool?
Music, Science, Art, Literature for Preschool?
Methods of Teaching Children?
Any Other Classes Related to Teaching Children?
Are You Certified in the Following Areas:
(please list current to oldest)
Name of Supervisor
Reason for leaving
Name, Address & Phone # of references you have known at least one year
Why are you interested in working with children?
Why are you interested in working with LPL?
Name of current LPL employee that recommended you
Have you ever worked with LPL before?
If so, when?
If so, what school?
Each school offers a babysitting service one Saturday night per month and on New Year's Eve.
Are you willing to work a few Saturday Nights a year?
How about New Years Eve?
Are you a citizen of the United States or do you have the legal right to be employed in the United States?
I certify that I qualify for the position I applied for according to the current edition of the THE MINIMUM RULES AND REGULATIONS FOR CHILDCARE CENTERS issued by the state of Colorado. I agree to comply with all of the requirements of the state manual. I further certify that the information given is true to the best of my knowledge.
If you are applying for an entry level position (Aide), the only state qualification for the position is to be 16 years old. If you are applying for any other position and you are unsure of the qualifications, please ask the schools director.
I agree to the above stated text
"Any applicant who knowingly or willfully makes a false statement of any material fact or thing in the application is guilty of perjury in the second degree as defined in section 18-8-503 CRS and upon conviction thereof, shall be punished accordingly."