Cornerstone Academy Day Center

2720 Arlington Drive

Alexandria, Va 22306
(703) 768-9355 (703) 768-9355 fax
email:cornerstoneacademy2@gmail.com
Employment Application
Personal Information
Name: ____________________________ Phone: ____________________
Address: ______________________________________________________
SSN: _____________________________________ Date of Birth: ___________
Position applied for: ________________________ Salary Req. _____________
Availability _______________________ Date you can start: _____________
Do you have any health problems that may interfere with fulfilling the job responsibilities
Yes _____No_____ if yes please explain
____________________________________________________________
Do you have children? No _____Yes _____ what are their ages? ______________
Education
Highest grade completed _________ High school diploma ____ yes ____ no ____ GED
College? Yes ___ no_____ Courses____________________________________
Experience
Place of employment: ______________________ Dates: __________________
Phone number: ____________________________ Position: __________________
Person to contact: __________________ Reason for leaving: _____________________
Place of employment: ______________________ Dates: __________________
Phone number: ____________________________ Position: __________________
Person to contact: __________________ Reason for leaving: _____________________
Reference:
Name: ____________________________ Phone: _________________________
Relationship: ________________________How long: ________________
Name: _____________________________ Phone: _________________________

Relationship: ________________________How long: ________________

Pastoral Reference:
Church Currently Attending______________________Phone Number_____________
Pastors Name___________________________________________________________
If you are hired for a position with our company, a pastoral letter is required
Do you have experience working with children? Yes_____ No ______
If yes please answer the following questions.
Length of experience: _________What age groups: __________
Job responsibilities: ___________________________________________________.
Training you have received in the childcare field: ______________________________
____________________________________________________________________.
Have you ever been charged/convicted of a felony or misdemeanor related to abuse,
neglect, or exploitation of children or adults? Yes ______ No ______
Are you willing to except training and supervision? Yes ______ No_____
Knowing that this center stresses a Christian Learning & Nurturing atmosphere, explain
why you wish to work here and what can you offer?
_______________________________________________________________________
_______________________________________________________________________.
Please explain your philosophy on discipline? __________________________________
_______________________________________________________________________.
I understand that monthly teachers meetings are mandatory and 16 hours of in-service
training is required per year.
Emergency Contact: Name:______________________________Phone:_____________
Relationship:_____________Address:_________________________________________
I have received & read the Staff Handbook and comply with the content
____________________________
Signature

________________________
Date

Interview questions: _____________________________________________________

____________________________________________________________________.
Start Date: ________________________ End of employment date: _____________