Children's Choice Site Director Application

First Name: Last Name: Middle Initial: Email:

Present Address:

How many years have you lived at this address? Phone: Second Phone:

Date of birth (only if under 18): Seeking: Full Time Part Time Hourly Wage

Hours per week: Kind of work desired:

Do you have any physical limitations or unusual health conditions which would affect your ability to perform duties of any particular position?
Yes No

If yes please explain:


Have you ever been convicted of a crime other than a minor traffic violation? Yes No

If yes please explain:


Have you ever had an arrest or substantiated referral to a child protective services agency? Yes No

If yes please explain:


What hours and days of the week are you available to work? Please be specific


High school: City & State:
Dates attended: Diploma GED None

College/University: City & State:
Dates attended: Yes: Degree No: Major

Other: City & State:
Dates attended: Major/Degree/Certificate:

Last (or present) Employer:

Name of Company:
Dates of Employment: Address:
Phone: Starting Job Title/Duties:
Ending Job Title/Duties: Starting Pay: Ending Pay:
Reason for leaving: Supervisor's name:

Next to last position:

Name of Company:
Dates of Employment: Address:
Phone: Starting Job Title/Duties:
Ending Job Title/Duties: Starting Pay: Ending Pay:
Reason for leaving: Supervisor's name:

Prior position:

Name of Company:
Dates of Employment: Address:
Phone: Starting Job Title/Duties:
Ending Job Title/Duties: Starting Pay: Ending Pay:
Reason for leaving: Supervisor's name:

Personal Refrences (other than supervisors above):
1. Name: Relationship: Occupation: Address: Phone #:

2. Name: Relationship: Occupation: Address: Phone #:

3. Name: Relationship: Occupation: Address: Phone #:

In case of Emergency Please Contact: Phone:

Entry-Level Position: School-Age Caregiver
EMPLOYMENT APPLICATION QUESTIONNAIRE

You are applying for a school-age care (SAC) program director position. The children who are enrolled in this program range in ages from five through twelve.
This is a pre-employment questionnaire. It is very important that you be honest when answering this questionnaire and that you answer each question. Marking an answer that does not best describe you, or leaving a question blank, could result in not being hired.
Please read and answer questions carefully and thoroughly. If you need more room to write, please use additional paper.

1. Why are you interested this particular job? How does it fit in with your long-term goals?

2. What do you like about the younger of our age group (5-8 year olds)?

3. What do you like about the older of our age group (9-12 year olds)?

4. What three or more qualities/qualifications do you have that would make you a good director of a school-age care program?

5. List all experience you have in working with school-age children.

6. What do you think children like about you?

7. What do you think your supervisors like about you?

8. What do you think your employees like about you?

9. What do you think your supervisors like about you?

10. What new skills do you hope to gain and/or what do you hope to learn from your experience as a school-age care program director?

Please describe how you would handle the following situations if you were the person in charge. Use a separate piece of paper if more space is needed.
1. You caught a normally well-behaved child running in an area where running is not allowed.

2. You caught a child who has a hard time following the rules running where running is not allowed.

3. A child you are responsible for keeps running ahead of the group on a nature walk.

4. A child in the program consistently plays alone.

5. You hear a child using a racial slur.

6. A parent disagrees with the manner in which you have disciplined his/her child.

7. You return from a field trip and discover a child has stolen something from the field trip gift shop.

8. A new child arrives into your program group halfway into the season.

9. A child tells you he/she is bored and doesn't like the activities.


What is your personal philosophy on discipline or behavior guidance? How do you typically prevent misbehavior? How do you typically deal with one time and chronic misbehavior? How do you manage the behavior of a group of children?


Supervisor Questions: 10. As a supervisor, how do you typically deal with conflict between two other staff members?


11. As a supervisor, how do you typically deal with individual staff performance problems?


12. How would you develop a developmentally appropriate curriculum to be administered by various employees?


13. What would you do if an employee complained to you that their co-worker isn't doing his/her share of the clean-up duties.


14. Two of your staff have frequent social conversations, while watching the children.


Thank you for taking the time to complete this segment of the application.

Please read before submitting

We appreciate your interest in a position with Children's Choice. If you have questions about making the following statement, please ask the interviewer to explain.

Statement of Applicant

In Children's Choice's effort to attract the highest quality staff, I have been advised that as a part of the application process for employment with Children's Choice, an extensive inquiry will be made concerning my prior employment, activities, character and health, and I fully consent to and authorize all such inquiries.

In the event of my employment by Children's Choice, I will comply with all policies set forth in the personnel policy and staff manual and with other policies established from time to time by Children's Choice. I understand that my initial employment is contingent upon receipt of a clear criminal records check from the FBI (requires being fingerprinted), three year employment history verification, certification by a physician or recognized health facility stating that I am free from tuberculosis in a transmissible form, and certification of successful completion of a recognized first aid and CPR course for infants and children.

Additionally, I authorize Children's Choice to request my employment performance record from any former employer(s). I further understand that inquiries may be made, concerning me, my background, experience, education and prior employment. Inquiries or requests may be made by Children's Choice, to any governmental agency, including law enforcement agencies or departments, or any other party with a legal and proper interest. I hereby waive any right to claim that any request for information or investigation is an invasion of my privacy, since they are made with my consent and it is in my interest that I be considered for employment.

I certify that I have never had an arrest or substantiated referral to a child protective services agency. I certify that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand and agree that any misrepresentation or omission of facts would exclude my being considered for employment or, after employment, would be cause for termination of employment with Children's Choice.

I understand and agree that if I am employed, there is no contract period for employment and my employment would be solely an "employment at will" giving either me or Children's Choice the right to terminate my employment at any time without liability or obligation except for my regular pay through date of termination. I understand that all program positions are temporary/term jobs, which expire when the program (Before & After- School Care, Vacation Camp, Enrichment Class) is off season.

I HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THE ABOVE STATEMENTS AND THAT I VOLUNTARILY SUBMIT THIS APPLICATION.