Name
Mailing Address
Telephone Number
Social Security Number
Date of Birth
Education (include type of Diploma or Degree received)
Describe any relevant training you have. Give date, location and name of organization sponsoring the training.
List any professional licenses or certificates you hold.
List any memberships in professional organizations you have.
Employment and Experience. List all positions held within the last 10 years with most recent position first.
If you haven?t been employed, list your whereabouts for the last 2 years. (State whether or not we may contact your previous employers for a reference)
Describe the duties of each position held in the area of child care (including direct care giving, supervision of childcare personnel or programs, management or administration).
Describe any other relevant experience or skills you have had. Give details, location, supervisor, etc.
Answer the following questions.
1) Have you ever been licensed to care for adults or children by the State of Alaska or by any other State? If Yes, where, when and for what type of care were you licensed?
2) Have you ever been denied a license or registration to care for adults or children, or had such a license revoked in Alaska or any other state? If Yes, where, when and for what type of care was the application denied or revoked?
3) Has a child for whom you were legally responsible for (biological child, foster child, adopted child, or child in your care) been removed from your home by the State of Alaska or a child welfare agency in another State, after an investigation of possible abuse and/or neglect? If Yes, please explain.
4) Has the State of Alaska or a child welfare agency in another State determined that you neglected or abused a child for whom you were responsible? If Yes, please explain.
5) Do you have any physical or mental problems, including alcohol or drug abuse, that might affect your ability to care for children? If Yes, please describe.
6) What is your present health condition? Excellent, Good, Fair, or Poor
7) Are you currently charged with a crime or have you been convicted of a crime within the past ten years? If Yes, give details, including date, place and nature of charge or conviction and disposition.
State that the information contained in the resume is true and complete to the best of your knowledge and belief. Please sign your resume before sending it to us.
Thank you,
Peanut Butter Pals Daycare Association
