Pre-Employment Application

Pre-Employment Application (All Information Required)

This application will be given every consideration, but its receipt does not imply the applicant will be employed. Each question should be answered in a complete and accurate manner as no action can be taken on this application until all questions have been answered.

First Name

Last Name

Your Email Address

Your Phone Number

Address

City, State

Zip Code

State Requirements to work in Child Care:

1. Are you a citizen of the U.S. or do you have the legal right to be employed in the U.S.?

YES NO

2. Are you 18 years old or older?

YES NO

3A. Are you a high school graduate or do you have a GED?

YES NO

3B. What year did you graduate or receive your GED?

4. Have you ever been convicted of any crime?

YES NO

If yes, state the offense, location, date and disposition:
(NOTE: A conviction will not necessarily disqualify you from employment.)

The location I am MOST interested in working at:

Dayton Academy/Dayton View Academy
Montgomery County
Miami University
Beavercreek Home Office
Miami Valley Hospital
Wright State University

Other locations I am interested in: (Select as many as applicable)

Dayton Academy/Dayton View Academy
Montgomery County
Miami University
Beavercreek Home Office
Miami Valley Hospital
Wright State University

I am applying for:

Click here to review our educational requirements by position

Teacher
Assistant Teacher
Support Staff
Substitute

Age Group Preference:

Infant
Toddler
Preschool
Kindergarten
School-Age

Years of TEACHING experience in an early childhood setting:

Years of OTHER experience working with young children:

Other Positions:

Clerical
Food Service
Administrator
Bus Driver

Full Time / Part Time:

Full Time
Part Time
If part time, please be specific:

Date Available To Start Working:

Are you willing and able to participate in work events occasionally in the evening and on weekends?

YES NO

Are there any days or times you are unable or unwilling to work?

YES NO

If yes, please specify:

Why are you currently searching for a new position?

Additional Information Required:

I am a currently enrolled student:

YES NO

Major:

School:

Education:
(Verification required at Initial Interview.)

CDA:

YES NO
Infant/Toddler		Date:
Preschool		Date:

Degree(s):

AA
BA
BS
MA
M.Ed.
Other

School #1

School:
Major:
Graduation Date:

School #2

School:
Major:
Graduation Date:

Total ECE Credits

Basic Health Classes:
I currently have training in the following classes:

Pediatric First Aid

YES NO

Date

CPR

YES NO

Date

Management of Communicable Diseases

YES NO

Date

Child Abuse Recognition/Prevention

YES NO

Date

I understand the above Basic Health Classes are a prerequisite for all center positions:

YES NO

If I do not have this training and am hired, I agree to complete this in my first 90 days:

YES NO

Compensation:
Save time - be honest! It helps you and us!

If I were offered a job today, the hourly wage must be $ for me to accept!

Benefits most important to me include:

Work History:
List most recent position first

Does your current employer know you are searching for a new position?

YES NO

Employer #1

Company Name & Address

Start Date (MM/DD/YYYY)

End Date (MM/DD/YYYY)

Pay

Supervisor Name

Supervisor Phone

Supervisor Email

Your duties and responsibilities

Your reason for leaving

Employer #2

Company Name & Address

Start Date (MM/DD/YYYY)

End Date (MM/DD/YYYY)

Pay

Supervisor Name

Supervisor Phone

Supervisor Email

Your duties and responsibilities

Your reason for leaving

Employer #3

Company Name & Address

Start Date (MM/DD/YYYY)

End Date (MM/DD/YYYY)

Pay

Supervisor Name

Supervisor Phone

Supervisor Email

Your duties and responsibilities

Your reason for leaving

References:
List three additional professional references other than family.

Reference #1

Name

Phone Number

How do you know this person?

Reference #2

Name

Phone Number

How do you know this person?

Reference #3

Name

Phone Number

How do you know this person?

Beliefs and Values:
The purpose of this assessment is to provide an opportunity for you to share the values and beliefs that guide your teaching practices. Complete the following sentences:

I think children are generally...

When children are unhappy, it's usually because...

I get angry when children...

All children are...

I wish parents would...

Professional Activities

Do you consider your work...

a Job a Career

How many hours of workshop/in-service credit did you earn last year?

0
1-5
6-10
11-15
16+

Did you enroll in any college courses for credit last year?

YES NO

Are you currently working toward a degree or credential?

YES NO

How many professional conferences/workshops did you attend last year?

None
1-3
4+

On the average, how many hours per week do you spend over and above what you are paid for in activities related to early childhood?

Hours

What professional organizations do you currently pay dues to?

How many professional books did you read last year?

None
1-3
4+

How many advocacy letters to elected representatives or to the editor of your local newspaper have you written during the past year?

None
1
2 or more

Do you expect to be working in the field of early childhood three years from now?

YES NO
Why?

Experience

1. I am committed to participating in on-going professional development.

YES NO Don't Know

2A. I am committed to supporting the emotional and educational needs of young children.

YES NO Don't Know

2B. My experience level in this area is:

High Medium Low

3A. I accept responsibility for intentionally preparing/maintaining an enriched learning environment.

YES NO Don't Know

3B. My experience level in this area is:

High Medium Low

4A. I accept responsibility for routinely assessing the needs of each child in my class.

YES NO Don't Know

4B. My experience level in this area is:

High Medium Low

5A. I enjoy using assessment information to differentiate and individualize instruction.

YES NO Don't Know

5B. My experience level in this area is:

High Medium Low

6A. I am passionate about nurturing children and responding to their interests and needs.

YES NO Don't Know

6B. My experience level in this area is:

High Medium Low

7A. Have you had any experience working with a particular curriculum?

YES NO Don't Know

7B. Name of Curriculum

7C. Brief explanation (what you liked or didn't like about this curriculum)

Pre-employment Responsibilities

I read the job description for the positions for which I am applying.

YES NO

I understand I will be required to obtain a pre-employment work physical.

YES NO

I understand I will be required to obtain a pre-employment fingerprint background check.

YES NO

I understand I will be required to obtain a pre-employment drug test.

YES NO

I certify that my answers to the foregoing questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application form or during any interviews may be grounds for my immediate discharge. I hereby authorize Mini University to contact any company or individual it deems appropriate to investigate my employment history, character, and qualifications, and I give my full and complete consent to their revealing any and all information they wish as a result of this investigation. In addition, I hereby waive my right to bring any cause of action against these individuals for defamation, invasion of privacy or any other reason because of their statements. I agree, that if I am employed, I will abide by all the rules and regulations of the company, and that my employment is "at-will".

Mini University, Inc. is an Equal Opportunity Employer and will consider all applicants for all positions equally without regard to their race, sex, age, color, religion, national origin, or handicap.

NAEYC Accredited since 1990