Full Name:

Last Name:

Middle Initial:

Home Phone:

Cell:

Alternate #:

Address:

State:

Zip Code:

DOB:

Soc. Sec. #:

Drivers License #:

Email:

Thank you for choosing Bitty Blessings Daycare & Preschool in your career path. We are dedicated to hiring top
professionals who are energetic, motivated, and possess integrity. Bitty Blessings is an Equal Opportunity
Employer. Applicants must show they understand and are able to meet the following Requirements for
Employment by initialing each item below.
Requirements for Employment (Please initial if applicable to You)
Is a High School Graduate or has G.E.D
Applicant must provide a copy of their drivers license or ID card and SS Card or birth certificate.
Applicant is able to write and speak fluent English.
Applicant is at least 18 years or older.
Has United States Citizenship, or is legally authorized to work in the United States.
Is able to sit on the floor and is able to get up and down from floor activities often.
Will maintain a Professional appearance and conduct
Has the ability to meet all job requirements which might vary.
Is able to drive a motor vehicle.
All hired employees are subject to Random Drug Test.
Respect Bitty Blessings facility as a drug free, alcohol free and smoke-free environment.

Educational Experience (Must provide copy of all certification)

High School attended and year graduated:
Degree(s) earned or expected:
_____________________________________________________________
Name of Institution:
Year(s) attended _____________________________________________________________
College course work completed relevant to this position:
_____________________________________________________________________________________

List all relevant training (CPR, First Aid, etc.):

__________________________________________________________________________________
List other relevant skills (office, clerical, achievements and training other fields):
_____________________________________________________________________________________

Employment History starting with current or most recent employer

Please complete the following regarding your employment history even if you do not think the questions relate
to the position you seek.
Employer Name _________________________________________________________________
Address _________________________________
Telephone Number (

) ______________________ May we contact?

_
Yes [ ]

No [ ]

Dates of employment: From__________________________ To ________________________

Position or Title ________________________________________________________________
Name/Title of Supervisor_________________________________________________________
Describe job duties, responsibilities and important accomplishments:______________________
____________________________________________________________________________
Starting Salary _____________________________ Ending Salary ______________________
Reason for leaving _____________________________________________________________
____________________________________________________________________________

Employer Name _________________________________________________________________

Address _________________________________
Telephone Number (

) ______________________ May we contact?

_
Yes [ ]

No [ ]

Dates of employment: From__________________________ To ________________________

Position or Title ________________________________________________________________
Name/Title of Supervisor_________________________________________________________
Describe job duties, responsibilities and important accomplishments:______________________
____________________________________________________________________________
Starting Salary _____________________________ Ending Salary ______________________
Reason for leaving _____________________________________________________________
____________________________________________________________________________

Employer Name _________________________________________________________________

Address _________________________________
Telephone Number (

) ______________________ May we contact?

_
Yes [ ]

No [ ]

Dates of employment: From__________________________ To ________________________

Position or Title ________________________________________________________________
Name/Title of Supervisor_________________________________________________________
Describe job duties, responsibilities and important accomplishments:______________________
____________________________________________________________________________
Starting Salary _____________________________ Ending Salary ______________________
Reason for leaving _____________________________________________________________
____________________________________________________________________________

Have you ever been discharged or forced to resign from a position?

If yes, explain

Yes

No

References
List three references not related to you and who are not previous supervisors.
Name

Relationship

Telephone

Years Known

1.__________________________________________________________________________
2.__________________________________________________________________________
3.__________________________________________________________________________

DISQUALIFYING CRIMES
Any employee or potential employee who is convicted, pleads guilty, or pleads nolo contender to any of the
following crimes will be disqualified from working at Bitty Blessings Daycare & Preschool, unless otherwise
provided by applicable law.
Child abuse Permitting child abuse Abandonment Endangerment Child abduction Child Pornography
Sexual abuse of a minor Sexual exploitation of a minor Corruption of a minor Crimes contributing to the
delinquency of a minor Negligent treatment of children Any crimes listed in the following sections which
relate to a minor Any criminal attempt, criminal solicitation or criminal conspiracy to commit any of the above
named offenses Crimes involving conduct similar to those listed above
Sexual abuse Sexual exploitation Sexual misconduct Sexual mischief Molestation Rape Carnal abuse
Sale or exhibition of obscene materials Sodomy Incest Any no-consensual or forcible sexual acts
Enticement for immoral purposes Prostitution Pandering Promoting prostitution Obscenity Public
sexual indecency Indecent exposure Criminal attempt, criminal solicitation or criminal conspiracy to commit
any of the above named offenses Crimes involving conduct similar to those listed above
Homicide Manslaughter Vehicular homicide Mayhem Assault or aggravated assault Battery or
aggravated battery Reckless endangerment Kidnapping Unlawful imprisonment Making terroristic threats
Sale, distribution or transportation of, offer to sell, transport or distribute or conspiracy to sell, transport or
distribute marijuana or narcotic drugs Theft Burglary Robbery or aggravated or armed robbery Arson
Domestic violence Gross irresponsibility or disregard of safety of others Any criminal offense involving fraud
or dishonesty Criminal attempt, criminal solicitation or criminal conspiracy to commit any of the above named
offenses Crimes involving conduct similar to those listed above.
Have you ever been convicted, plead guilty, or plead nolo contender to any of the following crimes listed on this
page?
Yes
No If Yes, please state the nature of the offense, where the offense occurred, date
and sentence imposed.

Conviction of a crime is not an automatic bar to employment. However, some positions may not be held by
persons convicted of certain crimes in accordance with state and federal law.

PLEASE ANSWER THE FOLLOWING QUESTIONS:

1. Why would you be a good hire for Bitty Blessings Daycare and Preschool?

2. If a child is a consistent biter, what would you do in your classroom to prevent and future incident and protect
the other children?

3. What actions would you take for parents who are unsupportive and uncooperative to suggestions made
regarding their childs disruptive behavior?

4. How would you handle disagreements between you and management and co-workers?

5. What are your strengths:

6. What are your weaknesses:

I, ________________________________________________________(print your name), understand that any

false answers or statements or omissions made by me on this application or any supplement thereto or any false
statements made to a representative of Bitty Blessings Daycare and Preschool during the interview process, will
be sufficient grounds for immediate discharge.

Signature

Date