Leapstart After School Teacher Application Form

Application for After School Helper (Substitute Teacher)

Your Full Name:*

Your D.O.B.:*

MonthDayYear

Your Phone:*

Your E-mail:*

Your Address*

Street Address

Street Address Line 2

CityState

Zip Code

Do you have prior working experience in after school or similar organization working with children ages 4-14?*

YesNo

Do you have early childhood education-Twelve Core Units Credits?*

YesNo

Are you consistently available during the week between 2PM - 6PM?*

YesNo

Do you consent to the background/ fingerprinting check?*

YesNo

Do you have first aid/ CPR certification or are you willing to obtain one?*

YesNo

Can you also pickup children from school?*

YesNo

Would you like to mention any prior/ current employer and/ or references? (We do not contact them without your consent)

Why are you interested in this Job?*

Please attach a soft copy of your Resume here:

Must be 21 to apply.