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Employment
Application

To ensure smooth processing, please fill out all required information on the form.

Personal Information

Are you at least 16 years old?
Desired Start Date
Month
Day
Year
Desired Schedule

Education

Date Graduated (High School)
Month
Day
Year
Date Graduated (College)
Month
Day
Year

Certifications

CPR/First Aid Certified?
(CPR/First Aid) Certification Expire
Month
Day
Year
Medication Administration Certified?
(Medication Administration) Certification Expire
Month
Day
Year
EpiPen Administration Training?
(EpiPen Administration) Certification Expire
Month
Day
Year

Employment History

1.

2.

3.

Childcare Experience

What age groups have you worked with?
Have you ever been responsible for lesson planning?
Are you familiar with Connecticut Early Learning and Development Standards (CT ELDS)?

Licensing and Background Questions

Have you ever been convicted of a crime that would affect your ability to work with children?
Are you willing to complete state and federal background checks?
Are you willing to complete DCF and child abuse registry checks?
Have you ever been terminated from a childcare position?
Have you ever had a professional license or certification suspended or revoked?

Availability

Days Available
Are you available to work until 5:30 PM?
Are you available for occasional staff meetings and trainings?
Are you available during school vacations and summer?

A Step Above-Specific Questions

References

Please provide two professional references:


2.

Application Confirmation

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