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23202 W. Lee Highway                                          101 Harmon Lane

Philadelphia, TN 37846                                           Lenoir City, TN 37771



Name_____________________________________________________________________

            Last                        First                     Middle                          Birthdate

Social Security Number___________________________________________

Address:______________________________________________________________________

                 Street

             ______________________________________________________________________

              City                                  State                    Zip                   Phone Number

Position Applied For ____________________________________________________________

Family member or other person to reach in an emergency

______________________________________________________________________________

Name                                        Relationship                               Phone Number

Educational Background (List Diplomas, Degrees, and Certifications)

TITLE                                       SCHOOLS/INSTITUTIONS                     ADDRESS

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Educational Experiences (List all training programs)

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Employment History (List most recent first)

Place/Phone Number                    Position                Dates                 Reason for Leaving

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Experiences with Young Children

Place                                  Purpose                   Date                      Contact Person

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

References (At least 3, including all former employers other than character references).

Name                          Address                   Telephone                     Contact Time

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Have you ever been convicted of a felony including any involving a suspended sentence?

Yes______________    No__________________

Have you ever been reported for child abuse or neglect? Yes____________ No_____________

If so, what and when?____________________________________________________________

14-10-129 states that each person applying to work with children as a volunteer or as a paid employee....shall complete an application on a form prescribed or approved by the Department of Human Services....It shall be unlawful for any person to falsify information required on the application.  Knowingly failing to disclose required information shall be deemed to be falsification to the same extent as providing false information.

By signing this form I am affirming that the above statements I have made are true and factual to the best of my knowledge and I am granting permission for all persons, organizations, or agencies listed above to be contacted for the purpose of employee screening.

___________________________                         ____________________________________

Date                                                                   Applicant's Signature

KIDDIE KINGDOM DAYCARE PRE-INTERVIEW QUESTIONNAIRE

-WRITE A SHORT SUMMARY EXPLAINING YOUR BACKGROUND AND EXPERIENCE THAT INVOLVES YOU WORKING WITH YOUNG CHILDREN.










-WHAT AGE GROUP DO YOU ENJOY WORKING WITH THE MOST? WHY?




-WHAT SORT OF ACTIVITIES DO YOU ENJOY DOING WITH A GROUP OF TODDLERS AND/OR PRE-SCHOOLERS?





-GIVE AN EXAMPLE OF TWO GROUP GAMES THAT YOU WOULD PLAY WITH TODDLERS & PRE-SCHOOLERS.


-WHAT ARE SOME CHILDREN'S SONGS THAT YOU CAN LEAD?



-WHAT IS YOUR PHILOSOPHY ON DISCIPLINE?



-WHAT DO YOU CONSIDER YOUR PERSONAL STRENGTHS?



-DO YOU FEEL THAT THESE PERSONAL STRENGTHS COULD HELP YOU IN THIS FIELD OF WORK?  IF SO, LIST HOW.




-PLEASE READ THE FOLLOWING SCENARIOS AND DESCRIBE HOW YOU WOULD HANDLE EACH SCENARIO.


-A PARENT COMES TO PICK HIS/HER CHILD  UP AND IS IN A VERY BAD MOOD.  HE/SHE STARTS COMPLAINING ABOUT THE CHILD BEING DIRTY FROM THE PLAYGROUND.  WHAT DO YOU SAY?





-YOU ARE SUPERVISING A GROUP OF 10 PRESCHOOLERS.  DURING ACTIVITY TIME YOU ARE TRYING TO HAVE AN EASEL PAINTING ACTIVITY FOR 4 KIDS, WHILE THE OTHER 6 ARE PLAYING IN THE BLOCK AREA AND HOUSEKEEPING.  THE KIDS IN THE BLOCK AREA AND HOUSEKEEPING.  THE KIDS IN THE BLOCK AREA GET INTO A FIGHT WHICH INVOLVES KNOCKING BLOCK BUILDINGS DOWN, HITTING EACH OTHER, AND YELLING.  HOW WOULD YOU TAKE CARE OF THIS WITHOUT THE REST OF THE ACTIVITIES FALLING APART?










-YOU ARE ONE OF TWO TEACHERS IN AN INFANT CLASSROOM WITH 8 INFANTS.  FOUR OF THE INFANTS ARE CRYING BECAUSE THEY ARE SLEEPY, 2 ARE CRYING BECAUSE THEY ARE READY FOR A BOTTLE, AND 2 ARE CONTENT TO PLAY ON THE FLOOR.  HOW WOULD YOU DEAL WITH THE 6 FUSSY INFANTS?





-YOU ARE SUPERVISING A GROUP OF 7 TODDLERS.  ONE TODDLER HAS A BITING PROBLEM AND IS CONSTANTLY GOING AFTER ONE PARTICULAR CHILD AND IS BITING HARD ENOUGH TO BREAK THE SKIN.  WHAT WOULD YOU DO TO PROTECT THE CHILD BEING BITTEN AND HOW WOULD YOU HANDLE THE CHILD DOING THE BITING?






-YOU ARE WALKING DOWN THE HALL AND OBSERVE ANOTHER CLASSROOM TEACHER YELLING AT A CHILD AND SMACKING THE CHILD'S HAND.  WHAT WOULD YOU DO?





-YOU FEEL THAT YOUR CO-WORKER IS NOT DOING HIS/HER SHARE OF THE WORK IN THE CLASSROOM.  HE/SHE IS ALSO NOT HANDLING THE CHILDREN IN A POSITIVE MANNER.  WHAT WOULD YOU DO?






-WHY HAVE YOU APPLIED FOR THIS JOB AND HOW DO YOU FEEL YOU CAN BE A POSITIVE ADDITION TO THIS COMPANY?






_______________________________              ___________________________________
APPLICANT'S SIGNATURE                             DATE