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Employment Application

Name (Last) (First) (MI) Today’s Date Current Street Address City State Zip Code ( ) ( ) Home Phone Number Cell/ Alternate Phone Number Social Security Number

Email Address

Which Bright Start Academy location are you interested in working at? (please circle all that apply) Overland St. Charles O’Fallon Lake St. Louis Columbia- Scott Blvd. Columbia- Bearfield Rd. Which type of position are you interested in?: Full-Time Part-Time Summer School Year Substitute Desired Wage: _______________/hour Desired Number of Hours Per Week: ________________

Hours of Availability:

Monday Tuesday Wednesday Thursday Friday

Date available to start working at Bright Start Academy: ______________________________________________________ Have you ever worked for Bright Start Academy before? Yes No If yes, when? ____________________________ Do you have any relatives that work for Bright Start Academy? Yes No If yes, who? ____________________ How were you referred to BSA? Current Employee Parent of a Child at BSA Website Online Recruiting Ad On my own Other Name of Referral Source ______________________________________________________________________________

Classroom Preference: Infant/ Toddler: Yes No Preferred Early Preschool (2 year-olds): Yes No Preferred Preschool (3 and 4-year-olds): Yes No Preferred Pre-Kindergarten: Yes No Preferred School Age: Yes No Preferred

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What position are you seeking? _________________________________________________________________________ What interested you in this position? _____________________________________________________________________ __________________________________________________________________________________________________ Describe your teaching philosophy: ______________________________________________________________________ __________________________________________________________________________________________________! Describe your approach to discipline: ____________________________________________________________________ __________________________________________________________________________________________________ Is there anything that may prevent you from satisfactorily performing the job for which you have applied? Please explain.

__________________________________________________________________________________________________ __________________________________________________________________________________________________

Personal Information Are you 18 years or older? Yes No Have you ever been charged or convicted of ANY crime (misdemeanor and/or felony) including, but not limited to, child abuse, child neglect or an unlawful sexual offense? Yes No If yes, please list dates of offense, charges, where it occurred and sentence: _____________________________________

__________________________________________________________________________________________________ (Please note that disclosure of a criminal record will not automatically disqualify you from employment with this company.) Are you willing to provide the necessary documentation to establish your identity and your eligibility to work in the United States under the Immigration Reform and Control Act of 1986? Yes No Do you have any children that would need child care at Bright Start Academy? Yes No

If yes, please list ages of children: _______________________________________________________________________

Do you have a valid driver’s license? Yes No Do you have a chauffeur’s (Class E) license? Yes No Do you have reliable transportation? Yes No

Education Name/ Location Highest Level/ Number

of Credit Hours Completed

Area of Study/ Major Did you Graduate?

High School

College/ University

Other/ Certificates

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Employment History Please list your employment history over the past five years, starting with the most recent. Complete this section, even if you have attached a resume.

Employer

Location

Dates Employed (Mo/Yr) From: To:

Hourly/Salary Starting: Ending:

Job Title Work Performed

Supervisor & Phone Number Reason for Leaving

May we contact your previous supervisor for a reference? Yes No

Employer

Location

Dates Employed (Mo/Yr) From: To:

Hourly/Salary Starting: Ending:

Job Title Work Performed

Supervisor & Phone Number Reason for Leaving

May we contact your previous supervisor for a reference? Yes No

Employer

Location

Dates Employed (Mo/Yr) From: To:

Hourly/Salary Starting: Ending:

Job Title Work Performed

Supervisor & Phone Number Reason for Leaving

May we contact your previous supervisor for a reference? Yes No

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References Please provide 3 references, not related to you.

Name Phone Number Relationship Years Known

Please initial your answers to the following questions:

*Missouri State Licensing requires an initial physical and TB test (or TB Risk Assessment Form). Will you comply within at least 30 days of your starting employment date? Yes ________________ No_________________

*Missouri State Licensing requires 12 hours of in-service training annually, prorated from date of hire, for each child care worker. You may also be required to complete additional training based on requirements at your particular center. Will you comply? Yes _____________ No_____________

*Missouri State Licensing requires that new childcare employees must fill out a Child Care Worker Registration Form to have a background screening done at the expense of the employee. Will you comply? Yes____________ No___________

Please list any conditions or limitations that might interfere with your work at Bright Start Academy. __________________________________________________________________________________________________

__________________________________________________________________________________________________

Person to notify in an emergency _______________________________________________________________________ Name Relationship Phone I hereby affirm that all of the information provided on this application for employment is complete and accurate to the best of my knowledge. I understand that any falsehoods, misrepresentations, or omission of information on this form may result in my denial of employment, or if employed, termination of employment at Bright Start Academy. I hereby authorize Bright Start Academy to verify all statements contained in this application to the fullest extent of the law. I understand that this application is not a contract, offer, or promise of employment. I understand that employment with Bright Start Academy is on an employment at will basis, which means the company or the employee may choose to terminate the employment at any time, with or without cause. Bright Start Academy is an Equal Opportunity Employer.

________________________________________________ ____________________________ Applicant’s Signature Today’s Date