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Supplemental Questionnaire

Last Name
First Name

 

Please complete the following supplemental questionnaire. This questionnaire is considered an extension of your employment application and will be reviewed to help assess your qualifications. Resumes are not accepted in lieu of completing this questionnaire.



 

You are applying for a position which requires working rotating shifts, including evenings, holidays, and weekends.  The primary duties include assisting staff in providing care for drug-exposed infants and children.  The infants, toddlers, and children may have behavioral and/or health issues.


1.

Have you read the the above information and understand that this position requires working rotating shifts includes evenings, weekends, and holidays?

Yes No
2.

Do you have at least six (6) months of full-time paid childcare experience in a licensed day care center or comparable group childcare program?

Yes No
3.

If you answered Yes, please describe your qualifying full-time paid work experience.  Include the name of the licensed day care center or comparable group childcare program, dates of employment, job title, number of hours worked per week, and the specific job duties performed.

4.

Posession of a valid California Driver's License may be required by the nature of the assignment.  Please provide your driver's license number and expiration date.