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EMPLOYMENT APPLICATION

The Goddard School does not discriminate in employment on the basis of age, race, color,
religion, sex, national origin, disability, veterans status or any other basis that is prohibited by
law. Goddard Schools are independently owned and operated under a license from Goddard
Systems, Inc. You are applying for employment with the independent contractor licensed to
operate a specific Goddard School. If you are hired, Goddard Systems, Inc. will not be your
employer. All aspects of the employment relationship, including the application process and
decisions regarding hiring, are solely between you and the prospective employer. Goddard
Systems, Inc. shall have no liability or responsibility to you for any acts or omissions of this
independent contractor, regardless of whether you are offered or accept employment.

Name InterviewDate
PERSONAL DATA
NAME LAST FIRST MIDDLE SOCIAL SECURITY NO.

ADDRESS NO. STREET CITY STATE ZIP CODE AREA CODE - PHONE NO.

PREVIOUS ADDRESS NO. STREET CITY STATE ZIP CODE DATES AT THIS ADDRESS

POSITION FOR WHICH YOU ARE APPLYING SALARY DESIRED DATE YOU CAN START

HAVE YOU EVER APPLIED TO THE GODDARD SCHOOL BEFORE?


Yes No If Yes,Location Date
ARE YOU EMPLOYED? IF SO, MAY WE CONTACT YOUR PRESENT EMPLOYER?
Yes No Yes No
HOW WERE YOU REFERRED TO THE GODDARD SCHOOL?

EDUCATION
ELEMENTARY AND MIDDLE HIGH COLLEGE
(CIRCLE LAST YEAR COMPLETED)
1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4
COURSE
NAME AND LOCATION OF SCHOOL
CLASSIFICATION GRADUATED
(CITY AND STATE)
MAJOR

High School Yes No

Correspondence
or Yes No
Business School
College or
University Yes No

College or
University Yes No

Other
Schooling or Training Yes No

GENERAL
SUBJECTS OF SPECIAL STUDY/RESEARCH WORK OR SPECIAL TRAINING/SKILLS
(You may exclude those which indicate race, religion, sex or national origin.)
EMPLOYMENT HISTORY (PLEASE COMPLETE THIS ENTIRE SECTION, EVEN THOUGH YOU MAY HAVE A RESUME)
List the names and addresses of previous employers.
Start with the present or latest employer and account for all periods of time.

COMPANY NAME POSITION HELD

ADDRESS NO. STREET CITY STATE ZIP CODE

EMPLOYMENT DATES SALARY


From To Beginning End
REASON FOR LEAVING

DESCRIPTION OF DUTIES

COMPANY NAME POSITION HELD

ADDRESS NO. STREET CITY STATE ZIP CODE

EMPLOYMENT DATES SALARY


From To Beginning End
REASON FOR LEAVING

DESCRIPTION OF DUTIES

COMPANY NAME POSITION HELD

ADDRESS NO. STREET CITY STATE ZIP CODE

EMPLOYMENT DATES SALARY


From To Beginning End
REASON FOR LEAVING

DESCRIPTION OF DUTIES

REFERENCES
(PLEASE LIST FOUR REFERENCES. DO NOT INCLUDE FAMILY MEMBERS.)

NAME ADDRESS PHONE NUMBER RELATIONSHIP


1.

2.

3.

4.

IunderstandthatemploymentwillbesubjecttomysubmittingdocumentaryproofofmyidentityandeligibilitytolegallyworkintheUnitedStates.
I understand that if employed, I will be an employee-at-will, which means that both the School and I can terminate my employment at any time, for
any reason consistent with applicable state and federallaw.
Iunderstandthatthisapplicationisnotacontractofemployment.
I understand that the School may thoroughly investigate my work and personal history and verify all data given on this application, on related papers
andininterviews.Iauthorizeallindividuals,schoolsandemployersnamedinthisapplication,exceptmycurrentemployerifsonoted,toprovideany
informationrequestedaboutme,andIreleaseallpartiesinvolvedfromanyandallliabilityarisingoutofthereleaseofthisinformation.
I certify that I am under no contractual obligations that would preclude me from working for theSchool.
IunderstandthatemploymentwithTheGoddardSchool,ifoffered,iscontingentuponmysatisfying,ataminimum,allofthestatesregulationsfor working in a
childcare facility including, but not limited to, regulations about arrests, if applicable, and criminalconvictions.
Icertifythatallthestatementsinthisapplicationaretrueandunderstandthatanyfalsifications,misleadinginformationormaterialomissionsmay
resultinrefusalofemployment,orifhired,mayresultinterminationofemployment.

SIGNATURE DATE
VALUES CLARIFICATION
Values are enduring beliefs-ideas that we cherish and regard highly. Values influence the decisions we make and the
courses of action we follow. Some values we prize more deeply than others; they become the standards by which we
live. The purpose of this assessment is to help you assess the values and beliefs that guide your teaching attitudes and
behaviors.

PART I (Complete the following sentences.)

1. I think children aregenerally

2. When children are unhappy, its usuallybecause

3. I get angry whenchildren

4. The most important thing a teacher can dois

5. Children shouldnot

6. All childrenare

7. I wish parentswould

8. Whenparents Ifeel

PART II
In the space provided, please write your teaching philosophy.

Form #935 8/2013

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