YMCA EARLY CHILDHOOD LEAP PROGRAM

APPLICATION FORM

Please complete this two-page application to apply for the YMCA’s Early Childhood Education LEAP (Learn as You Earn) training program that focuses on preparing young adults for careers in Early Childhood Education as teachers, teaching assistants, and aides. All applicants will be then be scheduled for an interview to complete the application process.

DEMOGRAPHIC INFORMATION

First & LAST name
Street Address & Apt# Address
ZIP CODE
Homephone
cellphone
EmailAddress

EDUCATION & CERTIFCATIONS

TYPE OF SCHOOL / NAME AND ADDRESS OF SCHOOL
(INDICATE CITY AND STATE) / COURSE OF STUDY / DEGREE RECEIVED / LAST YEAR COMPLETED
DEGREE/CERT.
HIGH SCHOOL
JUNIOR COLLEGE
COLLEGE
BUSINESS OR TRADE SCHOOL
GED or EQUIVELANCY
Are you currently or do you plan to register to complete a Certificate program related to early childhood work, education?
Examples might include theCDA[Child Development Associate Credential], theInfant Toddler Care and Education Credential

REFERENCES(Work or Personal, not family members)

NAME & RELATIONSHIP / PHONE / EMAIL

EXPERIENCE IN EARLY CHILDHOOD OR YOUTH WORK

Please describe any work, volunteer or internship experience you have had in the field of early childhood education, youth work, camp or other related programming. This is not a requirement of being granted admittance to this program.

AGENCY OR LOCATION / BRIEF DESCRIPTION

OTHER INFORMATION

OTHER TRAININGS OR CERTIFICATIONS YOU HAVE COMPLETED RELATED TO WORK WITH CHILDREN?
HOBBIES, SKILLS OR SPECIAL INTERESTS YOU HAVE THAT MIGHT BENEFIT WORKING WITH CHILDREN (ex. Art, computers, etc.)

SCREENING AND QUALIFICATION FOR THE PROGRAM AND INTERNSHIP

Due to the sensitive nature of working with young children, all trainees are required to undergo and pass (at no cost to you) the following screenings:
  • A background test and a drug test
  • A screening of them against the Statewide Central Register of Child Abuse and Maltreatment, as to the existence of any indicated reports of child abuse and maltreatment against an applicant prior to employment, certification, or licensure in the child care field
  • Fingerprinting by the Department of Investigation for the DOH and by the DOE

Do you acknowledge that you will have to go through these screenings to be accepted into the program? / YESNO
IF HIRED, CAN YOU FURNISH PROOF THAT YOU CAN LEGALLY WORK IN THE UNITED STATES? / YESNO
IF UNDER 18,
DO YOU HAVE WORKING PAPERS? / YESNO

Return this application with an updated resume to or

Y ROADS CENTER - 161-04 Jamaica Ave Jamaica, NY 11432-6112– Attn: LEAP Program