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 |
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|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) | | | | |
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|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 |
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|Have you ever been convicted of a felony and/or misdemeanor including deferred |
|Adjudication? ( Yes ( No If Yes, please explain: |
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|Are there any criminal charges pending against you? ( Yes ( No If Yes, describe: |
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|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 |
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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: |
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|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: |
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|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: |
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|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: |
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|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: |
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|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? |
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|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? |
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|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? |
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|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? |
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