Staff Application

Pecan Ridge School

1140 S. Buffalo

Canton, TX 75103

(903) 567-0515

Personal Information
Date:
Name:
Address:
Phone Number: ( )
Other: /
S.S. #
Age:
Position Desired: / Date You Can Start:
What age level of children do you prefer?
Educational Background
School Name and City / Field of Study / Degree
Check One:  High School Diploma  GED
College: 1  2  3  4 Degree:
Are you CPR/First Aid Certified? ____Yes ____No
Have you been FBI Fingerprinted? ____Yes ____No
Work Experience
Company Name and City / Phone Number / Position / Supervisor / Starting and Ending Wage
1)
2)
3)
May we have permission to contact your present employer?
List any previous experience you have working with children:
Position / Ages of Children / # of Children Involved
Have you ever been convicted of a felony and/or misdemeanor including deferred
Adjudication?  Yes  No If Yes, please explain:
Are there any criminal charges pending against you?  Yes  No If Yes, describe:
Personal Abilities and Information
Swimming Ability:
Musical Ability:
Any special ability in any field you feel would be an asset in your working with young children (arts & crafts, etc):
Any unusual medical problems?
In case of emergency, call:
What career do you intend to follow?
References (at least 3 of which are unrelated)
Name & Address / Phone Number / Relation

Will you attend 20-hours worth of training course per year?______

Are you willing to attend staff meetings?______

Can you start to work at 6:30am if necessary?______

Can you work as late as 6:00pm?______

Can you work a split shift 8:00-12:30 & 2:30-6:00pm?______

What hours do you prefer? (Preferred hours are not guaranteed):______

Will you take care of and return to the school your teaching materials when you leave our school?______

Will you pay for loss or damage to materials from your neglect (no normal wear)?______

Minimum salary you would consider?______

Pecan Ridge School is an Equal Employment Opportunity company dedicated to a policy of non-discrimination in employment on any basis including race, creed, color, age, gender, religion or national origin, or physical defects.

Insurance Information
The information requested below is needed for insurance. It is not used for hiring purposes.
Date of Birth
Marital Status / Spouse’s Name:
Names and ages of Children:
Texas Driver’s License No.
Please respond to the following questions with a written response.
Questions for teachers:
1. Abigail, a five year old, is trying to fasten the clasp on a necklace she found in the dress-up box. You sit next to her and discover she is squeezing the wrong part of the clasp. What can you do to help her? As a preschool teacher, you:
2. Olivia, who just turned two, takes Kristen’s crackers during snack time. Kristen begins to whimper and then cry. As a toddler teacher, you say:
3. Mikaela, who is six years old, is printing a message on a special card she is preparing for Mother’s Day. She asks you to write the message “I LOVE YOU” on the card. As a schooler teacher, you say:
4. Blair’s eyes are crossed. He is seven years old and comes to the center after school to be with other school-aged children. Some of the children call him “Crazy Cross Eyes.” As a care giver, you:
5. Johnny refuses to wear his jacket when he goes out to play on a warm day. His mother insists he wear the jacket and asks if Johnny has worn it. What should you tell the mother when she asks if he has worn it?
6. You are a van / bus driver for the center. You have just picked up children from public school and you are driving in a busy street when the bus breaks down. What do you do?
7. Zachary, a two year old, is playing with Avery when in a moment’s time he bites her on the arm. As a toddler teacher, what do you do with Avery? What do you say to Zachary? To the parents of each child?
8. Krista and the other three year old children are outside playing with your supervision. You are the only teacher with your class of thirteen. Krista falls off the play equipment and is lying on her back and says her back is hurting. What do you do?