Director Application – Children's Choice

Afterschool Program Director Employment Application

Site Director/Associate Director Application

How did you hear about this job/referred by:

Name

First Name

Last Name

Middle Initial

Email *

Present Address (Street, City, State, Zip)

How many years have you lived at this address?

Primary Phone # (could be cellphone) *

Other Phone Number

Emergency Contact Name (First and Last)

Emergency Contact Phone Number

Do you have any physical limitations or unusual health conditions which would affect your ability to perform duties of any particular position? If yes, please explain:

Do you have the physical ability to lift children (50lbs) as needed or physically separate children as needed and participate in housekeeping responsibilities?

Yes

If you are human, leave this field blank.