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Application for Employment

Stepping Stones Preschool

All information on this application must be truthful and correct. Falsification or


misrepresentation on the application is cause for immediate dismissal.

Name_______________________________________________________________________________

address_____________________________________________________________________________

County_________________________________City_____________________zip________________

phone numbers: _____________________________________citizenship__________________

d.o.b.______________________________________________social security #_________________

Emergency Contact Information:

name_____________________________________________________relationship______________

address___________________________________________________phone #__________________

Have you ever held a child care license with the dept of children and families or been
registered to provide child care in your home?________yes _________no

while employed in a child care program, have you ever been the subject of disciplinary
action, or been the party responsible for a child care facility receiving an admiinistrative
fine or other disciplinary action?________yes __________no

If yes, PLEASE EXPLAIN:

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