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First & Last Name

Phone Number (please format the number with hyphens or spaces)

Email Address

Position interested in (check all that apply) Position interested in (check all that apply) Teacher Teacher's Assistant Activity Leader

Do you have units in Child Development? Do you have units in Child Development? Yes No

How many Child Development units do you have?

Do you have college units (in any subject)? Do you have college units (in any subject)? Yes No

Enter the number of completed college units:

What is your highest level of education? What is your highest level of education? High School Diploma Enrolled in College Associate’s Degree Bachelor’s Degree

Do you have experience working with children? (explain):

What type of job are you looking for? What type of job are you looking for? Full time Part time

Have you ever been convicted of a felony or misdemeanor, or do you currently have a felony or misdemeanor charge pending? Convictions include a plea of guilty, nolo contendere (no contest) and/or a finding of guilty by a judge or a jury? (You will need to submit a background clearance and will not be eligible if you have any prior convictions.) Have you ever been convicted of a felony or misdemeanor, or do you currently have a felony or misdemeanor charge pending? Convictions include a plea of guilty, nolo contendere (no contest) and/or a finding of guilty by a judge or a jury? (You will need to submit a background clearance and will not be eligible if you have any prior convictions.) Yes No