Payroll Account Information



Staff Application

Pecan Ridge School

1140 S. Buffalo

Canton, TX 75103

(903) 567-0515

|Personal Information |

|Date: |

|Name: |

|Address: |

|Phone Number: ( ) |S.S. # |

|Other: |Age: |

|Position Desired: |Date You Can Start: |

|What age level of children do you prefer? |

|Educational Background |

|School Name and City |Field of Study |Degree |

| | | |

| | | |

| | | |

|Check One: ( High School Diploma ( GED |

|College: (1 ( 2 ( 3 ( 4 Degree: |

|Are you CPR/First Aid Certified? ____Yes ____No |

|Have you been FBI Fingerprinted? ____Yes ____No |

|Work Experience |

|Company Name and City |Phone Number |Position |Supervisor |Starting and Ending Wage |

|1) | | | | |

| | | | | |

|2) | | | | |

| | | | | |

|3) | | | | |

| | | | | |

|May we have permission to contact your present employer? |

|List any previous experience you have working with children: |

|Position |Ages of Children |# of Children Involved |

| | | |

| | | |

| | | |

| | | |

| | | |

|Have you ever been convicted of a felony and/or misdemeanor including deferred |

|Adjudication? ( Yes ( No If Yes, please explain: |

| |

| |

| |

|Are there any criminal charges pending against you? ( Yes ( No If Yes, describe: |

| |

| |

| |

|Personal Abilities and Information |

|Swimming Ability: |

|Musical Ability: |

|Any special ability in any field you feel would be an asset in your working with young children (arts & crafts, etc): |

|Any unusual medical problems? |

|In case of emergency, call: |

|What career do you intend to follow? |

|References (at least 3 of which are unrelated) |

|Name & Address |Phone Number |Relation |

| | | |

| | | |

| | | |

| | | |

| | | |

Will you attend 20-hours worth of training course per year?____________

Are you willing to attend staff meetings?_______________

Can you start to work at 6:30am if necessary?_____________

Can you work as late as 6:00pm?__________

Can you work a split shift 8:00-12:30 & 2:30-6:00pm?__________________

What hours do you prefer? (Preferred hours are not guaranteed):__________________

Will you take care of and return to the school your teaching materials when you leave our school?________________

Will you pay for loss or damage to materials from your neglect (no normal wear)?____________________

Minimum salary you would consider?______________________________

Pecan Ridge School is an Equal Employment Opportunity company dedicated to a policy of non-discrimination in employment on any basis including race, creed, color, age, gender, religion or national origin, or physical defects.

|Insurance Information |

|The information requested below is needed for insurance. It is not used for hiring purposes. |

|Date of Birth |

|Marital Status |Spouse’s Name: |

|Names and ages of Children: |

| |

| |

| |

|Texas Driver’s License No. |

|Please respond to the following questions with a written response. |

|Questions for teachers: |

|1. Abigail, a five year old, is trying to fasten the clasp on a necklace she found in the dress-up box. You sit next to her and |

|discover she is squeezing the wrong part of the clasp. What can you do to help her? As a preschool teacher, you: |

| |

| |

| |

| |

| |

|2. Olivia, who just turned two, takes Kristen’s crackers during snack time. Kristen begins to whimper and then cry. As a toddler |

|teacher, you say: |

| |

| |

| |

| |

| |

|3. Mikaela, who is six years old, is printing a message on a special card she is preparing for Mother’s Day. She asks you to write |

|the message “I LOVE YOU” on the card. As a schooler teacher, you say: |

| |

| |

| |

| |

| |

|4. Blair’s eyes are crossed. He is seven years old and comes to the center after school to be with other school-aged children. Some|

|of the children call him “Crazy Cross Eyes.” As a care giver, you: |

| |

| |

| |

| |

| |

|5. Johnny refuses to wear his jacket when he goes out to play on a warm day. His mother insists he wear the jacket and asks if |

|Johnny has worn it. What should you tell the mother when she asks if he has worn it? |

| |

| |

| |

| |

| |

|6. You are a van / bus driver for the center. You have just picked up children from public school and you are driving in a busy |

|street when the bus breaks down. What do you do? |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

|7. Zachary, a two year old, is playing with Avery when in a moment’s time he bites her on the arm. As a toddler teacher, what do |

|you do with Avery? What do you say to Zachary? To the parents of each child? |

| |

| |

| |

| |

| |

| |

| |

| |

|8. Krista and the other three year old children are outside playing with your supervision. You are the only teacher with your class|

|of thirteen. Krista falls off the play equipment and is lying on her back and says her back is hurting. What do you do? |

| |

| |

| |

| |

| |

| |

| |

| |

| |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download