First Name Middle Name Last Name Social Security No. - - Address (street number and name) City State. County Zip Cell Telephone Home Phone

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1 Date of Application First Name Middle Name Last Name Social Security No. - - Address (street number and name) City State County Zip Cell Telephone Home Phone Date of Birth / / month day year Driver s License Number Issuing State Are you willing drive the school van? Address: Position Applied For Permanent full-time Permanent part-time Substitute/Temporary Lead Teacher (must have NCECC minimum) Check age group preference Infants Toddlers Schedule List Preferred Hours? Teacher Floater Chef Two Year Olds Four Year Olds Kindergarten Three Year Olds TK Afterschool Possible scheduling conflicts? Can you open 7:00am? Can you close 6:00pm? Education highest level completed: College: Graduate School: Schools Name and Location Dates Attended Course of Study Degree or Diploma High School Date Awarded College or University Graduate or Professional Special training programs or coursework you have completed in the last five years (list): Current professional status: Certification Level Membership in professional, honorary or technical societies (list):

2 Work Hisry May Providence Preparary School ask your present employer about your character, qualifications, and employment records? A No will not Affect you consideration for employment opportunities. (Start with the present position and go back 10 years. You may include volunteer work. Account for periods of unemployment in separate blocks in order.) 1 Most Recent Employer Dates of Employment (Month & Year) Average hours per week 2 Dates of Employment (Month & Year) Average hours per week 3 Dates of Employment (Month & Year) Average hours per week 4 Dates of Employment (Month & Year) Average hours per week

3 References Give a minimum of three references, not relatives or former employers, who know you know you professional, through community involvement and personally. Name Telephone Occupation Please Answer the Following Questions: Criminal hisry includes county, state, and federal convictions or pending indictments of any of the following crimes as set forth in the Following Articles of Chapter 14 of the North Carolina General Statutes ( NCGS ) : Article 6, Homicide; Article 7A, Rape and Kindred Offenses; Article 8, Assaults; Article 10, Kidnapping and Abduction; Article 13, Malicious Injury or Damage by Use of Explosive or Incendiary Device or Material; Article 26, Offenses Against Public Morality and Decency; Article 27, Prostitution; Article 39, Protection of Minors; Article 40, Protection of the Family; and Article 59, Public Inxication; violation of the North Carolina Controlled Substances Act, Article 5 of Chapter 90 of the NCGS, and alcohol-related offenses such as sale underage persons in violation of NCGS 18B-302 or driving while impaired in violation of NCGS through NCGS ; or similar crimes under federal law or under the laws of other states. Have you ever been convicted of breaking a law other than a minor traffic violation? YES NO If yes, give the date and explain fully on an additional piece of paper if more space is needed Have you ever had a Department of Social Services (DSS) substantiation? YES NO If yes, list county/state and give the date and explain fully on an additional piece of paper if more space is needed (The offense(s) and how recently you were convicted will be evaluated in relation the job for which you are applying.) Are you at least 18 years of age and legally eligible for work in the United States? Will you work after hours and weekend special events when necessary? Are you on layoff and subject recall? Are you currently bound by a noncompetition or trade secret agreement? Have you been discharged or asked resign from a job? If yes, please explain Do you have physical limitations that limit or restrict you from lifting or caring children? If yes, please explain Is childcare desired? If yes, list ages of children AFFIDAVIT OF APPLICANT: I certify that I have given true, accurate, and complete information on this form the best of my knowledge. In the event confirmation is needed in connection with my work, I authorize educational institutions, associations, registration and licensing boards, and others furnish whatever detail is available concerning my qualifications. I authorize investigations of all statements made in this application and understand that false information of documentation, or a failure disclose relevant information may be grounds for rejection of my application, disciplinary action, or dismissal if I am employed, and (or) criminal action. I further understand that dismissal on unemployment shall be mandary if fraudulent disclosures are given meet position qualifications. I understand that acceptance of this Application of Employment by Providence Preparary School ( PPS ) shall not be construed by me as an offer or invitation work for, be hired by or become employed by PPS. Applicant s Signature: Date:

4 Pre-Interview Questions 1. Why are you interested in working for Providence Preparary School? 2. If you were choosing a school for your child or a friend s child, what would you look for? 3. What is the most important quality you have offer children? 4. Describe a situation where you planned an activity for children that did not work out? 5. What is your preferred curriculum and are you willing learn how implement new/multiple curriculums? 6. Are you interested in training others on specific skills you believe you have mastered? Please list pics. 7. What are the specific things that you do establish a positive relationship with parents?_

5 8. If a parent ask you suggest a children s book, what would you recommend and why? 9. If you had a role in selecting your co-workers what quality would you look for? 10. In your last teaching job how did you handle.? Discipline Biting Parent Complaints Conflict with co-workers Crying

6 11. If a parent or ur group walked in your classroom what would they observe? 12. Where do you see yourself in five years? 13. Are you satisfied with your career path in Early Childhood Education? Please feel free tell is anything you would like us know about you. If mailing application please send : Providence Preparary School Attn: Employment Applications 3031 Providence Road Charlotte NC 28211