Discovery Preschool
225 North Street
Emmaus, Pa. 18049

Phone: 610-967-1441

Email: Dispre@aol.com

Contact Discovery Preschool

    Please fill in the application form below if you are interested in employment at the Discovery Preschool.

Personal Information

First Name:
Last Name:
Street Address:
City:
State:
Zip:
E-mail:
Phone:
Birthday:
Social Security #:
 

Employment Desired

Position:
Date Available:
Salary Desired:
Are you currently employed?
Yes:     No:
If so, may I contact your current employer?
Yes:     No:
 

Education

Schools Attended:




Dates Attended:




Degree/Major:





Please list any courses, volunteer work, hobbies, or interests that would relate
to the position you are applying for. If you will be furnishing a resume,
please type "See Resume" in the box.
Please list any community organizations you are active in.

 

Former Employers
Please list your last four employers starting with the most recent.

1. Employer Name & Address:
Start/End Dates:
Position:
Salary:

2. Employer Name & Address:
Start/End Dates:
Position:
Salary:

3. Employer Name & Address:
Start/End Dates:
Position:
Salary:

4. Employer Name & Address:
Start/End Dates:
Position:
Salary:
 

References
Please list two persons not related to you, whom you have known at least one year.

Name:


Phone:


 

Physical Record

Do you have any physical condition(s) which may limit your ability to perform the job applied for?
Yes:     No:
If yes, please explain:

Emergency Notification:
Name:
Address:

Relationship:
Phone:
 

General Information
1. Prior to employment, employees must submit a health form filled out by their doctor including evidence of freedom from Tuberculosis.

2. In compliance with the Department of Welfare requirements, no person shall be hired or retained as a staff member,
paid or volunteer, who has:
  • •  been convicted of or admitted to or been subjest of substantial evidence of an act of child battering, child abuse, or child molesting.
  • •  used alcohol or drugs such that its effects are apparent during working hours that children are in care, or
  • •  been convicted for or admitted to any felony or any offence involving moral turpitude.

I understand that any misrepresentation or omission of facts in this application is cause for dismissal.
You are about to digitally sign a legal application as per The E-Signature Act that was effective on October 2000.

Signature (please use full legal name):
Today's Date: