Application Date *

Date Available: *

Full Name: *

Please list any other names you have worked under.

Complete Address: *

Phone Number: *

Email Address: *

Can you submit verification of your legal right to work in the US? *

Christian Background: What is your home church? *

Christian Background: In what church activities are you involved in? *

Christian Background: Are you capable of teaching a Christian Curriculum? If yes, what would be your age preference? *

Christian Background: Please summarize any additional information that you would like to present regarding your candidacy for this position. *

Professional Qualifications: High School or GED? *

Professional Qualifications: Name of School or Program. *

Professional Qualifications: College Education *

Professional Qualifications: Degree, Date, and Institution Received? *

Professional Qualifications: Early Childhood Courses? *

Employment History *Sequentially list any employment with most recent first. Please clearly indicate if you do not want us to notify your current employer* : Company? *

Employment History *Sequentially list any employment with most recent first. Please clearly indicate if you do not want us to notify your current employer*: Dates of Employment? *

Employment History *Sequentially list any employment with most recent first. Please clearly indicate if you do not want us to notify your current employer* : Position? *

Employment History *Sequentially list any employment with most recent first. Please clearly indicate if you do not want us to notify your current employer* : Supervisor Name and Phone Number? *

Employment History *Sequentially list any employment with most recent first. Please clearly indicate if you do not want us to notify your current employer*: Reason for Leaving? *

Employment History *Sequentially list any employment with most recent first. Please clearly indicate if you do not want us to notify your current employer* : Company?

Employment History *Sequentially list any employment with most recent first. Please clearly indicate if you do not want us to notify your current employer*: Dates of Employment?

Employment History *Sequentially list any employment with most recent first. Please clearly indicate if you do not want us to notify your current employer* : Position?

Employment History *Sequentially list any employment with most recent first. Please clearly indicate if you do not want us to notify your current employer* : Supervisor Name and Phone Number?

Employment History *Sequentially list any employment with most recent first. Please clearly indicate if you do not want us to notify your current employer*: Reason for Leaving?

List 2, unrelated, Professional and/or Christian References (Name and Phone Number). *Please note by putting their names and phone numbers you are giving LLCC permission to contact them* *

What would you like to be doing five years from now? *

How did you learn about this position for which you are applying? *

G. APPLICANT'S CERTIFICATION AND AGREEMENT: I understand that Little Lambs Christian Center (LLCC) does not discriminate in its employment practices against any person because of race, color, national or ethnic origin, gender, age, or qualified disability. I hereby certify that the facts set forth in this application process are true and complete to the best of my knowledge. I understand that falsification of any statement or a significant omission of fact may prevent me from being hired, or if hired, may subject me to immediate dismissal regardless of the time elapsed before discovery. If I am released under these circumstances, I further understand and agree that I will be paid and receive benefits only through the day of release. I authorize LLCC to thoroughly interview the primary references which I have listed, any secondary references mentioned through interviews with primary references, or other individuals who know me and have knowledge regarding my testimony and work record. I also authorize LLCC to thoroughly investigate my work records and evaluations, my educational preparation, and other matters related to my suitability for the position. I authorize references and my former employers to disclose to LLCC any and all employment records, performance reviews, letters, reports, and other information related to my life and employment, without giving me prior notice of such disclosure. In addition, I hereby release LLCC, my former employers, references, and all other parties from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure. I waive the right to ever personally view any references given to LLCC. I authorize LLCC to conduct a criminal background check. I understand and agree that any offer of employment that I may receive from LLCC is conditioned upon the receipt of background information, including criminal background information. LLCC may refuse employment or terminate conditional employment if LLCC deems any background information unfavorable or that it could reflect adversely on LLCC or on me as a Christian role model. I understand that this is only an application for employment and that no employment contract is being offered at this time. I certify that I have carefully read and do understand the above statements. *

By signing your name electronically on this Application, you are agreeing that your electronic signature is the legal equivalent of your manual signature on this Application Form. Thank you for your interest in employment with Little Lambs Christian Center. *Please type your full name and date.* *