Title
DR MISS MR MRS MS

First Name *

Last Name *

Home Address *

City *

State *

Zipcode/Postcode *

Country *
UNITED STATES

Home Phone Number *

Email Address *

Are you CPR Certified?
-- Please select -- Yes No

If yes, when does your certificate expire?

Are you First Aid Certified?
-- Please select -- Yes No

If yes, when does your certificate expire?

Are you EEC (formerly OCCS) Teacher Qualified?
-- Please select -- Yes No

If Yes, what specific certificates do you have?

Use 3 words to describe your teaching style:

What importance do these three words play in your teaching of young children?

What makes a successful early education program?

What areas of expertise and additional skills can you bring to Little Sprouts?

Type of employment desired:
Full Time Part Time Substitute/Floater

Have you ever been convicted of a crime or a DSS or EEC allegation?
-- Please select -- Yes No

If yes, please explain:

Are you currently under investigation by DSS, EEC, or any other agency?
-- Please select -- Yes No

If yes, please explain:

Are you a citizen of the U.S. or legally able to work in the U.S.?
-- Please select -- Yes No

Are you a previous applicant?
-- Please select -- Yes No

Part Time: Check the days and indicate the times you are available to work:
Day of Week: Monday Tuesday Wednesday Thursday Friday
Time of Day: Mornings Afternoons

Other:

What is your desired annual salary?

Please check which centers you are willing to work at:
Andover Brighton Haverhill@Lowell Ave Haverhill@NECC
Lawrence Lowell Methuen Roxbury Westford
Woburn

Are you over the age of 16?
-- Please select -- Yes No

Are you a previous employee?
-- Please select -- Yes No

If yes, please list the school, position and supervisor:

When did you last apply?

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