Employment Application - Open Arms Child Development Center

16. Have you been convicted of a criminal offense (felony or serious misdemeanor)? If yes, state law may prohibit you from working in a licensed childcare facility.

Yes No

17. Have you obtained a current Criminal History Report for Interested Parties from the State of Alaska?

Yes No

17a. If yes, date of report

18. Oher than English, what languages do you speak?

19. Do you have a valid State of Alaska Driver’s License, if required for the position you are applying for?

Yes No

19a. Expiration Date

19b. Driving Restrictions? (A DMV report will periodically be obtained during employment if driving is required.)

20. If you are hired, can you provide proof that you are eligible to work in the United States? (Proof of citizenship or immigration status will be required upon employment)

Yes No

21. Are you willing to participate in continuing education and training for this position?

Yes No

22. List current professional Licenses, certificates, or memberships in professional organizations.

23. EDUCATION, High School: School, Location Dates Attended Year Graduated

24. EDUCATION: College/University: School, Location, Dates Attended, Degree & Year Graduated

25. EDUCATION: Vocational/Technical School: School, Location, Dates Attended, Degree & Year Graduated

26. EDUCATION: Other Relevant Training

27. EMPLOYMENT & EXPERIENCE: List all positions held in the last 10 years, beginning with the most recent. You may provide this information in resume format. If you were not employed, list your whereabouts for the last 2 years.

27a. Describe any duties of your above positions that are relevant to childcare or adult care, including direct care giving, supervision of child or adult care, personnel or programs, management, or administration.

28. Other relevant work experiences, including volunteer work

29. SPECIAL SKILLS AND QUALIFICATIONS: Please describe any special skills or other experience which may qualify you for the position for which you are applying, include when, where, and how acquired.

30. REFERENCES List at least three references, not related to you, and not previous employers, who can comment on your character and your ability to work with children.

31. I give the director of Open Arms Child Development Center of her/his assigns, the right to investigate all references and to secure additional information about me, if job-related. Furthermore, I give the employer the right to verify any educational reference give in this application, I hereby release, from liability, the Employer and its representatives for seeking such information and all other corporations, educational institutions or organizations for furnishing such information

32. It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer’s service if I have been employed.

33. In the event of my employment by the Open Arms Child Development Center I agree to abide by all present and subsequently issued rules of Open Arms.

34. If employed, I will be required to complete an Employment Verification Form (I-9) and within three days show satisfactory evidence of identity and eligibility for employment.

35. Open Arms Child Development Center is AT-WILL EMPLOYER. I acknowledge that there is no specific length of employment and that any verbal or written offers of employment do not constitute and agreement or contract for employment. Accordingly, either Open Arms Child Development Center or I can terminate the employment relationship at will, with or without cause or notice, so long as the termination does not violate law or public policy.

36. Have you been previously licensed to care for child(ren) or adults?

Yes No

36a. If yes, indicate city, state, and type or care (childcare home, child or adult foster care, etc.) and dates of licensure:

37. Have you ever had a license to care for children or adults revoked or denied in Alaska or any other state?

Yes No

37a. If yes, explain details.

38. Have you ever been investigated for child or elder abuse or neglect?

Yes No

39. Do you have any physical health, mental health or behavioral problem that might pose a risk to the health, safety or well being of children or adults?

Yes No

39a. If yes, please explain.

40. Have you been convicted of a crime or charged with criminal offense in the last 10 years?

Yes No

40a. If yes, please explain.

41. Have you ever been convicted of or charged with a felony, crime involving domestic violence, or a sex crime?

Yes No

41a. If yes, please explain.

42. I certify that the contents of this form and information provided with it are true, accurate and complete. I authorize the employer to contact others to verify information contained here.

ADDITIONAL QUESTIONS (Use separate sheet if necessary.)

43. Describe your experience for the position for which you are applying.

44. What do you envision as safe, healthy, Christian learning environment for young children?

45. How would you describe your relationship with Jesus Christ?

46. Why would you be an asset to the families and staff of Open Arms Child Development Center?

47. Describe your experience in maintaining timely and accurate records.

OPTIONAL QUESTIONS - NOT REQUIRED

48. Are you a member of a local church congregation?

Yes No

48a. If yes, name of congregation:

48b. May we contact your pastor for a reference?

Yes No

48c. Name of Pastor & Phone Number

Open Arms Lutheran Child Development Center is operated in accordance with U.S. Department of Agriculture (USDA) policy which prohibits discrimination on the basis of race, color, national origin, sex, age or disability.

Fairbanks Alaska

Application for Employment

Open Arms Child Development Center