First Name: Last Name:

Street Address: City: State: Zip:

Home Phone: Cellphone: Birthdate:

Present Occupation: Gender Select Gender MALE FEMALE

Email Address: Work Email Address:

Educational Background

Education	Name of School	Current Year or Last Year Completed	Did You Graduate?	Year Graduated	Degree and/or Major
High School		1 2 3 4	YES NO
College		1 2 3 4	YES NO
Post College		1 2 3 4	YES NO
Trade School		1 2 3 4	YES NO

Work Experience (List PAID EXPERIENCE in order of most recent position.)

Type of Work	Organization	Dates	Employer	Phone

Volunteer Experience (List any VOLUNTEER EXPERIENCE you have had.)

1.
2.
3.

Experience with Children (What related experience with children have you had? Teaching, babysitting, etc. (include ages & gender)

Certifications - Please indicate any CURRENT certifications you have below.

Child Care Certifications	American Red Cross/YMCA Certifications
Teacher Certification	Lifeguard Training	Responding to Emergencies
CDA Certification	Lifeguard Training Instructor	Community CPR
Associates Degree	Water Safety Instructor (WSI)	CPR for the Professional Rescuer
Other (specify)	Standard First Aid	Other (specify)

Character and References - List 3 people who know of your work such as teachers, employers, etc. No family members, please.

	Name	Address	Phone Number
1.
2.
3.

Have you ever been charged, either criminally or civally, with sexual abuse, sexual harassment or discrimination? YES NO
Have you ever been convicted of a felony? YES NO
If you answered YES to either of the last two questions, please explain.

Activities - Select "LIKE" next to the activites that you like to do. Select "TEACH" next to activities that you could teach or help teach.

LIKE TEACH Arts & Crafts	LIKE TEACH Science	LIKE TEACH Music	LIKE TEACH Nature
LIKE TEACH Cooking	LIKE TEACH Sports	LIKE TEACH Singing	LIKE TEACH Dance
LIKE TEACH Gymnastics	LIKE TEACH Photography	LIKE TEACH Improv/Theatre	LIKE TEACH Carpentry
Other:

Are you available to work weekday mornings?

The following question is to prevent spam and must be answered correctly to submit the application. The color of a ripe pumpkin is...?