Welcome!

We are so excited that you have expressed interest in becoming a part of our child care team! We are always looking for qualified individuals who are ready to jump on board at KidTowne. We offer flexible hours of employment to our customers as well as to our employees. Employment at KidTowne is an exciting as well as an enriching experience. If you love children and are ready to play a significant role in their lives, please provide the following information!

  1. Personal Information

Contact Information
Name:
Street Address:
City: / State: / Zip Code:
Phone: / Cell: / Email:

Desired Position (circle all that apply): Lead TeacherAssistant TeacherFloater

Date You Can Start: ______

Are you interested in full time or part time hours? ______

Have you ever been convicted of a felony and / or a misdemeanor? ______

If yes, please explain: ______

______

  1. Employment History

Please enter information for your three most recent employers

Current/most recent employer
Employer name:
Location: / Dates of employment:
Position: / From: / To:
Reference name:
May we contact? / Reference contact info:
Reason for leaving:
Previous employer 1
Employer name:
Location: / Dates of employment:
Position: / From: / To:
Reference name:
May we contact? / Reference contact info:
Reason for leaving:
Previous employer 2
Employer name:
Location: / Dates of employment:
Position: / From: / To:
Reference name:
May we contact? / Reference contact info:
Reason for leaving:
  1. Education

High School
High School Name:
Years Attended / From: / To: / Graduated Y N GED
Address / Street:
City: / State: / Zip:
Special studies:
College
College Name:
Years Attended / From: / To: / Graduated Y N
Address / Street:
City: / State: / Zip:
Degree/studies:
Other
Years Attended / From: / To:
Address / Street:
City: / State: / Zip:
Degree/certificate/studies:
  1. Multiple Languages, Areas of Special Study, Applicable Experience or Talents

Languages Spoken and/or Written:

Special Areas of Study/Research:

Other Applicable Experience, skills or talents:

  1. References

Please provide 3 professional references. Please, no friend or family references. List one former employer.

Reference 1
Name:
Address:
Relationship:
Phone:
Email:
Reference 2
Name:
Address:
Relationship:
Phone:
Email:
Reference 3
Name:
Address:
Relationship:
Phone:
Email:
  1. Availability

We employ both regularly scheduled teachers and on-call teachers. Please indicate your availability and interest in these two types of positions in the tables below.

Please mark all times you are available and interested in working regularly in the table below:

Day / Mon / Tue / Wed / Thu / Fri / Sat / Sun
Early AM (6-9) M-F
Morning (9-12)M-Sa
Afternoon (12-6)
Evening (6-10) M-Su
Evening(10-12)Fr-Sa

Please mark all times you are available and interested in being on call in the table below:

Day / Mon / Tue / Wed / Thu / Fri / Sat / Sun
Early AM (6-9) M-F
Morning (9-12)M-Sa
Afternoon (12-6)
Evening (6-10) M-Su
Evening(10-12)Fr-Sa
  1. Age group interests

Please mark your interest level in working with each of the following age groups and programs:

Highly interested / Interested / Less interested
Infants (0-18 months)
Toddlers (18-30 months)
Preschool program (2.5-4 years)
School age (5-12 years)
  1. Certifications and Signature

I CERTIFY that the facts presented in this application are true and complete to the best of my knowledge.

In the event of employment, I UNDERSTAND that should any statements made in this application or during the interview process prove to be false, that this maybe grounds for immediate dismissal.

I UNDERSTAND that there is no stated or implied minimum length of employment and that should I be hired, I agree that my employment may be terminated at any time, without prior notice,or just cause.

I UNDERSTAND that all common areas within KidTowne are under video surveillance at all times. These recordings may be used in the investigation of employees.

I UNDERSTAND that all claims and disputes arising under or relating to this Agreement are to be settled by binding arbitration in the state of Alabama or another location mutually agreeable to the parties. An award of arbitration may be confirmed in a court of competent jurisdiction.

I AUTHORIZE KidTowneto investigate all statements made in this application and to contact any references given, while releasing KidTownefrom any liabilities and/or damage caused.

I certify that I am legally entitled to work in the United States and that all permits are currently valid.

Signed: ______Date:

Administration use only:

Signature of Director: ______Date Hired: ______

Position Awarded: ______

KidTowne is an Equal Opportunity Employer. Applications are considered without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job related medical condition or handicap.

Employee File Checklist

*The following items must be on file before employment will be fully enacted:

_____Application (fill out online and submit)

_____ Three Reference Letters (sent from KidTowne to references provided by applicant)

_____Physician Release Form (included-print, obtain physician clearance, and return)

_____Minimum Standards Verification Form (included-print and return)

(for standards, go to:

_____Copy of current Driver’s License

_____Copy of Social Security Card

_____CPR/First Aid Certificate

_____Certificates Verifying 12 Training Clock Hours in Child Care (within 30 days of employment)

_____High School or College Transcript

_____A copy of the Criminal History Information Consent and Release Form. (complete online- print and return)

(go to:

_____A copy of the Mandatory Criminal History Check Notice. (from DHR)

_____Request for Clearance of State Central Registry on Child Abuse/Neglect (complete and submit online)

(go to:

_____ A Suitability Determination letter from the Department. (from ABI and FBI)

MEDICAL REPORT FOR PERSONS GIVING CARE TO CHILDREN

Name:

Date of birth:

Address:

Position in child care facility:

To the examining medical doctor, physician's assistant, or certified nurse practitioner:

This examination is needed to determine my physical ability to care for children or

to perform services in a child care facility (home or center) or to have contact with children

in care. I hereby authorize you to furnish a report of my examination to:

______

Name of child care facility or Department of Human Resources

______/______

Signature Date

______

TESTS (to be completed if other verification is not attached):

Date and result of Intradermal Tuberculin Test (Mantoux): ______

(Required for initial examination only)

Date and result of chest x-ray if Mantoux was positive: ______

HISTORY of any chronic disease or disability that may affect his/her ability to care for children

or perform services in a child care facility: Yes _; No _.

PHYSICAL LIMITATIONS that may affect his/her ability to care for children or perform

services in a child care facility (home or center): Yes _; No _.

If "YES", to either question, please explain:

______

______

In my opinion, the physical examination reveals that the above-named person is free of any

infectious or contagious disease and is physically fit to care for children, to perform services in a

child care facility, or to have contact with children.

If not, please explain:

______

______

______/______

Signature of medical doctor, physician's assistant, or certified nurse practitioner / Date

VERIFICATION THAT STAFF PERSONS HAVE READ THE

MINIMUM STANDARDS

Written and signed verification stating that staff persons have read the Minimum

Standards within one month of employment, must be in each staff person's file in the

center.

I have read the Minimum Standards for Day Care Centers and Nighttime Centers. I

understand that I must comply with these regulations while I am employed at

______

(Name of center)

Failure to do so could result in immediate termination of employment.

______

Signature of staff person Date

______

Signature of Licensee/Director Date