Personal Information

Name

Nantucket Address

Permanent Address

City

State  Zip

Phone Number

Second Phone Number

Email Address

Are you at least 18 years of age? Yes, No

Are you prevented from lawfully becoming employed in this country because of visa or immigration status? Yes, No

Employment Desired

Postion applied for

Date Available to Start

Have you ever applied to Small Friends before? Yes, No

Referred by

General

Special Areas Of Interest

Special Skills

Education

High School

Name of School

Subjects

Degree Earned

College

Name of School

Subjects

Degree Earned

Graduate

Name of School

Subjects

Degree Earned

Other

Name of School

Subjects

Degree Earned

Have you ever taken a course in child development or child psychology? Yes, No

Employment History

References

Please give the names and phone numbers of three people not related to you whom you have known for at least one year.

Reference #1

Name

Phone Number

Business

Reference #2

Name

Phone Number

Business

Reference #3

Name

Phone Number

Business

Emergency Contact

In case of emergency please notify: