The Little School of Hillsborough, NC
301 College Park, Hillsborough NC 27278
A 5 Star preschool and child development center offering
a nurturing, exploratory, educational program.

Plese fill out this form as completely and accurately as possible.

Application for Employment

Personal Information

Date of Application

* Last Name

* First Name

* Middle Name

* Address 1

Address 2

* City

* State

* Postal Code

* County

* Phone (home or where you can be reached)

Business Phone

* Email Address

NC Driver's License Number

* Are you over 18 years old?

yes

* Position Applying For

* Are you legally authorized to work in the United States?

Yes

* Have you ever been convicted of breaking a law other than a minor traffic violation? (The offense and how recently you were convicted will be evaluated in relation to the job for which you are applying.)

Yes

If yes, give the date and explain fully

Education

* Highest Grade Completed

	Name and Location	Dates Attended	Courses of Study	Degree/Diploma
High School
High School
College or University
College or University
College or University
College or University
College or University
Graduate or Professional
Graduate or Professional
Educational or Vocational Schools, etc.
Educational or Vocational Schools, etc.

Please list any Child care training you have completed in the last three years (such as first aid, CPR, CDA etc.):

Work History (List child care/early childhood experience first.)

Employer

Address

Job Title

May we contact your employer?

Yes

Supervisor's Name

Phone

From (MM/YYYY)

Staring Salary

Ending Salary

Reason for Leaving

To (MM/YYYY)

Duties

No. Supervised by you.

Time worked

	Full Time	Years	Months	Hours Per Week
Full Time
Part Time

Employer

Address

Job Title

May we contact your employer?

Yes

Supervisor's Name

Phone

From (MM/YYYY)

Staring Salary

Ending Salary

Reason for Leaving

To (MM/YYYY)

Duties

No. Supervised by you.

Time worked

	Full Time	Years	Months	Hours Per Week
Full Time
Part Time

Employer

Address

Job Title

May we contact your employer?

Yes

Supervisor's Name

Phone

From (MM/YYYY)

Staring Salary

Ending Salary

Reason for Leaving

To (MM/YYYY)

Duties

No. Supervised by you.

Time worked

	Full Time	Years	Months	Hours Per Week
Full Time
Part Time

References

Name

Title

Phone

Email Address

Name

Title

Phone

Email Address

Additional Skills

List any additional skills that you would like to mention.

Please submit a copy of your resume. (optional)

Please submit a copy of your cover letter (optional).

I certify that I have given true, accurate, and complete information on this form to the best of my knowledge. In the event confirmation is needed in connection with my work, I authorize educational institutions, associations, registration, and licensing boards, and others to furnish whatever detail is available concerning my qualifications. I authorize investigations of all statements made in this application and understand that false information of documentation, or a failure to disclose relevant information may be grounds for rejection of my application, disciplinary action, or dismissal if I am employed, and (or) criminal action. I further understand that dismissal on unemployment shall be mandatory if fraudulent disclosures are given to meet position qualification.

* Full Name of Applicant (in lieu of signature)

* Date

* Indicates Response Required