Super Kids Place                                   Application for Employment
Name                        Last                                    First                             Middle                             Maiden
Home Address                                                    street                              City                 State                           Zip
Home phone:                              Cell Phone:
Birthdate                   Attach Copy of Birth Certificate and Driver License
Social Security No. 
Education:  
1. Did you complete high school?    NO      Yes
2. Did you complete any of the following?       No     Yes
45-hour course for:  Infant        School Age 
90-hour course for:    Infant/Toddler           School Age 
Other:  Child Care Development Associate Credential 
3. Did you attend College?    NO    Yes
4. Did you earn a degree?    NO     Yes
Year                 Name of College                 Degree Earned 
(Attach college certificate or transcript)
 Provide information about your supervised experience working with groups of children in licensed childcare centers, public or private schools as a registered provider or other approved settings. Attach documentation from each employer, which states the number of hours worked, the ages of the children, your position and the length of time worked.
Dates Worked     Name of Facility (Start with present employer) Position     Ages        #Hours Worked  
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3. 
Provide 3 references. Name, phone, relationship: 
Signature (I confirm that the above information is true and correct to the best of my knowledge.)