Social Security Number

Phone Number

Email

Driver's License Number

Have you ever been charged with or convicted of any crime against a child? (If yes, explain)

Has any founded report of child maltreatment ever been made against you? (If yes, explain)

Has a court ever denied parental, custodial, or visitation rights as a result of neglect of abuse of a child? (If yes, explain)

Have you ever been convicted of a crime? (If yes, explain)

Are you willing to submit to a background check? (If no, explain)

List special certificates (CPR, First Aid, EMT, RN, include dates of expiration)

How would you rate your ability with children?

How would you rate your people skills?

EDUCATION:

High School / GED (Name, location, grade completed, date of completion):

College / University (Name, location, grade completed, date of completion):

College Major:

Degree:

Any advance degree or course work:

CHILDCARE EXPERIENCE:

Please list any childcare experience you have had.

Desired position:

Health

Do you have any physical limitations which would give you problems in performing this job? (If yes, explain)

EMPLOYMENT HISTORY:

List your work history below. (Please attach resume.)

Employer Name, Address, Phone Number

Duties

Supervisor

Reason for Leaving

Employer Name, Address, Phone Number

Duties

Supervisor

Reason for Leaving

Employer Name, Address, Phone Number

Duties

Supervisor

Reason for Leaving

PERSONAL REFERENCES

List three individuals (non-relatives) who are familiar with your qualifications and personal background. Include phone numbers.

Reference #1

Name, Relationship, and Phone Number:

Reference #2

Name, Relationship, and Phone Number:

Reference #3

Name, Relationship, and Phone Number:

The mission of Rogers First Church of the Nazarene is to connect people to a Vibrant Life in Jesus Christ. The facilities and resources of Rogers First Church are dedicated to the ministries of leading people into a personal relationship with Jesus Christ, Christian nurture, enrichment of church families, and providing a place where Christian young people and adults can devote themselves to Christian Service.

Signature:

Childcare Employment Application

Rogers First Church of the Nazarene

Location

Hours

Contact

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