Employment Application

Personal Information:

Full Name:*

First Middle Last

Phone Number:*

Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email:*

Are you the age of 18 or older?*

Are you under the care of a physician?*

If yes, please explain:*

Are you able to lift up to 25 lbs?*

If no, please explain:*

Have you ever been convicted of a crime?*

If yes, please explain:*

Are you presently employed?*

Which Center are you interested in?*

Christiansburg GAC Center
Radford GAC Center

What position you are applying for?*

What is your preferred age group?*

What is your Early Childhood Education experience?*

Are you interested in full-time or part-time work?*

Expected Salary:*

Will you have a child attending Grace-A-Child?*

If yes, children's ages:*

Educational Background:

Please list previous employment, starting with the most recent (You may email a resume below with additional information).

High School:*

Received High School Diploma or Equivalent?*

College:*

Received College Degree or Equivalent?*

Major:*

Please list previous employment, starting with the most recent (You may upload a resume below with additional information).

Please list 3 Professional References: Name, Address, Phone Number

1)*

2)*

3)*

Do you have any special skills or talents that would be beneficial in working with young children?*

(Please include administrative, organizational, and communication skills.)

What 3 words describe your personality? (Describe their relation in working in a children’s program.)

#1*

#2*

#3*

Parents:*

Children:*

Life Shaper:*

What do you think makes a successful Academy?*

What behavior do toddlers and pre-school ages children exhibit when they are bored?*

As a Life Shaper, what steps would you take to inform a parent of an accident? Confront a parent of a distruptive child? Respond to a voiced concern?*

What are your future professional goals?*

Where is your spiritual development?*

Just Beginning
Making Progress
Growing
Advanced

Please provide us with your profession of faith below:*

Staff Availability Information:

This section is to gather information to be efficient in communication. We will use it to increase the effectiveness of our classroom coverage, as well as covering changes in ratio, school-age early releases, emergencies, and weather delays.

List your weekly availability in the space provided below.

Please upload your class schedule, other job schedule, and prior commitments if any below:

Class Schedule:
Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB.

Other Job Schedule:
Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB.

Prior Commitments:
Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB.

Monday:*
Please be detailed with the hourly time windows of which you are available to work, including times that will allow scheduling for ratio changes, emergencies, and weather related delays.

For example: A daily morning schedule may reflect 7:00am – 3:00pm, but in the case of hourly delays (1 or 2 hour delay), would be available to work until 4:30? Or an afternoon schedule may reflect 1:00 pm – 6:00 pm, but in case of early release would you be avilable to work starting at 12:00 pm?

Tuesday:*
Please be detailed with the hourly time windows of which you are available to work, including times that will allow scheduling for ratio changes, emergencies, and weather related delays.

For example: A daily morning schedule may reflect 7:00am – 3:00pm, but in the case of hourly delays (1 or 2 hour delay), would be available to work until 4:30? Or an afternoon schedule may reflect 1:00 pm – 6:00 pm, but in case of early release would you be avilable to work starting at 12:00 pm?

Wednesday:*
Please be detailed with the hourly time windows of which you are available to work, including times that will allow scheduling for ratio changes, emergencies, and weather related delays.

For example: A daily morning schedule may reflect 7:00am – 3:00pm, but in the case of hourly delays (1 or 2 hour delay), would be available to work until 4:30? Or an afternoon schedule may reflect 1:00 pm – 6:00 pm, but in case of early release would you be avilable to work starting at 12:00 pm?

Thursday:*
Please be detailed with the hourly time windows of which you are available to work, including times that will allow scheduling for ratio changes, emergencies, and weather related delays.

For example: A daily morning schedule may reflect 7:00am – 3:00pm, but in the case of hourly delays (1 or 2 hour delay), would be available to work until 4:30? Or an afternoon schedule may reflect 1:00 pm – 6:00 pm, but in case of early release would you be avilable to work starting at 12:00 pm?

Friday:*
Please be detailed with the hourly time windows of which you are available to work, including times that will allow scheduling for ratio changes, emergencies, and weather related delays.

For example: A daily morning schedule may reflect 7:00am – 3:00pm, but in the case of hourly delays (1 or 2 hour delay), would be available to work until 4:30? Or an afternoon schedule may reflect 1:00 pm – 6:00 pm, but in case of early release would you be avilable to work starting at 12:00 pm?

Applicant Acknowledgement:*
By completing this application, you give permission for Grace-A-Child to contact your references, verify your past work history, conduct a criminal background check, verify your driving record, and contact your previous employers to determine your suitability in working in the child care center.
By signing this application, you affirm that the information is true to the best of your knowledge. You also agree to release the center for any liabilities that result from the verification. Thank you.
First Last

Grace-A-Child USA Academy Employment Form

Personal Information:

Educational Background:

Employment History:

1) Reference

2) Reference

3) Reference

4) Reference

Professional References:

Staff Availability Information: