Iowa State University
College of Human Sciences


Child Development Laboratory School

Employment Application

* Required Fields

*Name
*Address
*Home Phone
Cell Phone
*E-mail
*Major
*Year in School
*As required by DHS, a criminal history and child abuse background check is completed on all staff. Have you ever been convicted of a crime that may make you ineligible for employment? Yes
No
If so, please explain:
Special Training: - CPR
- First Aid
- Universal Precautions (Blood-borne Pathogens)
- Mandatory Child Abuse Reporting
- Other:
Are you willing to work in the kitchen? Yes
No
Are you eligible for work-study? Yes
No
Can you work during spring break? Yes
No
Can you work during the summer semester? Yes
No
Can you work over any of the other breaks? Yes
No
Please describe your experiences with young children
Please list your class schedule below (days/times of courses):

First Reference:

* Required Fields

*First Name
*Last Name
*Address
*Phone
*E-mail
*Relationship

Second Reference:

* Required Fields

*First Name
*Last Name
*Address
*Phone
*E-mail
*Relationship