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YES NO Expiration Date: Food Handler's Certification? YES NO Other training/titles/certifications: Have you worked in a licensed child care/preschool facility in the past? YES NO Are you currently employed? YES NO May we contact your employer? YES NO When are you available to work if hired? MM slash DD slash YYYY What experience do you possess in working with children?Current/Former EmployersEmployer 1Starting Date MM slash DD slash YYYY Ending Date MM slash DD slash YYYY Name of Employer, city, state Pay Rate Supervisor's Name Reason for leaving:Employer 2Starting Date MM slash DD slash YYYY Ending Date MM slash DD slash YYYY Name of employer, city, state Pay Rate Supervisor's Name Reason for leaving:Employer 3Starting Date MM slash DD slash YYYY Ending Date MM slash DD slash YYYY Name of employer, city, state Pay Rate Supervisor Reason for leaving:REFERENCESReference 1Name: Known How Long? Relationship: Telephone: Reference 2Name: Known How Long? Relationship: Telephone: Reference 3Name Known How Long? Relationship: Telephone: Specific Employment PreferencesPosition Seeking: Lead Teacher Assistant Teacher Full-Time Part-Time Year-Round Summer Only Check the program/s for which you are applying: Toddler (1-2 year olds) Preschool (3 year olds) PreK (4 year olds) School-age (Kinder-5th Grade) What do you see yourself doing in five years? Previous Salary? Salary Expectations? Referred By? Heritage is open from 6:30am-6:30pm. Do you have any schedule conflicts that would prohibit you from working between these hours? If so, please explain: I AGREE WITH THESE STATEMENTS OF EMPLOYMENT: All staff must submit evidence that they are free of Tuberculosis before employment. TB tests can be obtained through your regular physician or any healthcare clinic. In compliance with the Texas Department of Human Services, no person shall be hired or retained as a staff member, paid or volunteer, who has: Been convicted of, or admitted to, or been the subject of substantial evidence of an act of child battering, child abuse, or child molestation; Used alcohol or drugs such that its effects are apparent during working hours that children are in care; or Been convicted of or admitted to any felony or any offense involving moral turpitude. I understand that once hired, I am not guaranteed a specific classroom or assignment and that observations will be conducted of me to determine the best place for me in the school. It is up to the director and the scheduler to place teachers where needed. I authorize an investigation of all statements contained in this application. I authorize all persons listed as well as former employers/employees of past businesses in which I’ve worked to give a reference for me. I understand that misrepresentation or omission of facts or information requested on this application is cause for dismissal. I understand that nothing in this application, or in any prior or subsequent written or oral statement, creates a contract of employment or any rights in the nature of a contract. I agree and understand that if I am hired by HLC, my employment will be at-will, for an indefinite period of time, and may be terminated at any time, with or without cause or notice, at the option of HLC or myself. I understand that I have the right to end my employment at any time and that HLC retains that same right. Signature: Date MM slash DD slash YYYY Are you more organized or creative? Please choose only one. Explain.Do you enjoy leading others in tasks or assisting others to get a task done?What do you think is the most important task of a preschool teacher?Sing your own praises. What is the best thing about you? This is your chance to share your best characteristic. Explain why you think so.What are you looking for in this opportunity?