Application for Employment

Stepping Stone Children's Center
189 Log Canoe Circle
Stevensville,  MD  21666

Date of Application:    //

Position(s) applying for:   
Referral Source:    Advertisement Other Friend Walk-in Child in center

Personal Information

Name:                                                     Social Security Number:     --
Street Address:  
City:                           Zip code:                                Home Phone:     --

What date are you available to start work:      //                                    Work Preference:    Full Time Part Time Substitute

Educational Information

High School:                                    Year of Graduation:   

College       :                                    Year of Graduation:                Degree:   

List all childhood courses taken:           
                                                           
                                                           
                                                           
                                                           

Special skills/qualifications:

References

Please give the name, address, and telephone number of three references who are not related to you and are not previous employers.

Name:                                                                 
Street Address:   
City:                             Zip code:                                Phone:     --

Name:                                                                 
Street Address:   
City:                             Zip code:                                Phone:     --

Name:                                                                 
Street Address:   
City:                             Zip code:                                Phone:     --

Employment References

Company Name:                                      
Street Address:    
City:                             Zip code:                       Phone:     --
Position:                                                      Supervisors Name:   
Dates of Employment:    From:    Mo.   Year         To:  Mo.  Year 

Company Name:                                      
Street Address:    
City:                             Zip code:                       Phone:     --
Position:                                                      Supervisors Name:   
Dates of Employment:    From:    Mo.   Year         To:  Mo.  Year 

Company Name:                                      
Street Address:    
City:                             Zip code:                       Phone:     --
Position:                                                      Supervisors Name:   
Dates of Employment:    From:    Mo.   Year         To:  Mo.  Year 

You may choose to e-mail the application or you can simply print this form and bring it with you to the Main Center for your interview.  If you choose to e-mail the application, please contact Carol Blodgett, Krista Long, or Stacy Blodgett at the Main Center (410-643-4181) to arrange for an interview.