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Applying at Country Home is simple using our secure online application form below. Upon receiving your application, we will be in touch as quickly as possible.If you’d like to submit your application in person, click the link to the right to download, print, and return completed to your nearest location.

Please select the location at which you’d like to apply and then fill out our employment application in full. Upon receiving your application, we will be in touch as quickly as possible. Thank you.

Select Location *


How did you hear about Country Home?*

PERSONAL INFORMATION

All Personal Information fields are required. The application will not be able to be submitted unless all the Personal Information fields are filled.

First Name

Last Name

Your Email

Address

City

State

Zip

Phone

Are you 18 years or older? YesNo

Are you a relative of a Country Home employee?

YesNo

If yes, who?

Are you currently legal to work in the U.S.? YesNo

EMPLOYMENT DESIRED

Position (must specify position - do not answer "anything")

Date you can start?

Salary Desired

Are you employed now? YesNo

If so may we inquire of your present employer?
YesNo

Have you applied at Country Home before?
YesNo

If so, when and at which location?

Have you worked at Country Home before?
YesNo

If so, when and at which location?

The position you have applied for may require you to obtain and maintain a commercial driver's license. If so, we will be required to check your driving record through the Dept. of Motor Vehicles. Please provide the following information regarding your current driver's license:

Driver's Lic. Number:

State:

Please also provide any information which might affect your insurability or ability to obtain a commercial driver's license:

State law requires that a criminal history check be done on all child care personnel. Have you ever been convicted, plead guilty, or no contest to a misdemeanor or felony in any State? If yes provide details:

EDUCATION

High School

High School Name & Location

Number of Years Attended

Graduated? YesNo

Subjects Studied:

College

College School Name & Location

Number of Years Attended

Graduated? YesNo

Subjects Studied:

Post Grad

Post Grad School Name & Location

Number of Years Attended

Graduated? YesNo

Subjects Studied:

Other

Other School Name & Location

Number of Years Attended

Graduated? YesNo

Subjects Studied:

Please describe any subjects of special study, areas of experience, skills, or special talents or interests:

Former Employers and References

FORMER EMPLOYERS (most recent first)

Employer 1

Start Date / Finish Date

Name & Address

Ending Salary

Position

Reason for Leaving

Employer 2

Start Date / Finish Date

Name & Address

Ending Salary

Position

Reason for Leaving

Employer 3

Start Date / Finish Date

Name & Address

Ending Salary

Position

Reason for Leaving

Employer 4

Start Date / Finish Date

Name & Address

Ending Salary

Position

Reason for Leaving

REFERENCES

You MUST include 3 work related references to be considered for a position.

Reference 1

Name

Address

Phone

Work Relationship

Years Acquainted

Reference 2

Name

Address

Phone

Work Relationship

Years Acquainted

Reference 3

Name

Address

Phone

Work Relationship

Years Acquainted

Applicant Questionnaire

1. What are your strengths?

2. What are your weaknesses?

3. What would you like to be able to do better?

4. How would you handle a screaming 2 year old?

5. How would you handle a child using foul language?

6. How would you handle a 1 year old who bites?

7. What is the most important thing a parent wants to hear about their child at the end of the day?

8. How many days a month can a teacher be absent?

9. How do you handle criticism?

10. When you are not finished with certain tasks by the end of the day, would you be willing to stay late to complete them?

11. How often do you attempt to learn more about your job in order to improve your performance?

12. How would you present a special event to children that you do not personally enjoy?

13. If you are having a problem at work would you discuss it with co-workers, tell your supervisor, or solve it yourself?

14. How would you respond if asked to complete a task not in your job description?

15. Do you mind sharing your work space, or would you prefer to have your own work space?

16. Do you prefer to work in a structured environment or an environment that allows more choices?

17. Have you won any awards or scholarships for overall success in school or in the workplace?

18. If you fail at a task how do you respond?

19. Do you enjoy helping others achieve a similar measure of success to yours?

20. How would someone describe your most common emotion?

21. What do you plan to be doing 1 year from now?

PHYSICAL RECORD

Are you physically and mentally able to perform all functions of the job for which you are applying?
YesNo

If "No", state the function(s) you cannot perform, and what accommodations by us, if any, would enable you to perform them:

In care of emergency, please notify:

Name

Address

Phone

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. My typed signature below certifies that I acknowledge all statements made on this application are true and complete.

I hereby (1) authorize investigation of all statements contained herein and I further authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and (2) authorize investigation of any previous scholastic records, and pursuant to the Family Education Rights and Privacy Act of 1974, I authorize release of my education records by an education or institution which I have attended. I release all parties from all liability whatsoever for any damage, direct or indirect, that may result from furnishing such information to you.

I understand and agree that, subject to the terms and condition of any employment contract, if hired, my employment will be at will and may be terminated at any time without prior notice. I am under no obligation, nor will my employer be under any obligation, to renew any employment contract.

Date

Signature (by typing your name you are providing consent to the above statements)

Country Home Learning Center is an equal opportunity employer. Federal law prohibits discrimination on the basis of race, color, religion, sex, national origin or disability. It is our policy to comply fully with these laws; information requested on this application will not be used for any purpose prohibited by law.

Your application will be considered active for 30 days; you must reapply for consideration after that time. All blanks on this form must be completed in order for your application to be considered.

For security purposes, please answer this question in order to submit your application: