Application Form


Please complete the entire application.

It is the policy of Imagine Early Education and Childcare to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.

Applicant Information

Have you lived in another state in the last five years?

Emergency Contact

Job Information

Do you have any friends or relatives who work here? *
Have you applied to our company previously *
Are you willing to work any shift, including evenings? *
Are you available to work overtime or outside of your regularly scheduled shift? *
Are you able to submit proof that you are legally eligible for employment in the United States? *
Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation? *

Applicant's Skills

Check those skills that you have. List any other skills that may be useful for the job you are seeking. Enter the number of years of experience and check the number which corresponds to your ability for each skill. (One represents poorability, while five represents exceptional ability.)

Customer Service (Years of Experience) *
Customer Service (Ability or Rating) *
Child Care (Years of Experience) *
Child Care (Ability or Rating) *
Computer/tablet (Years of Experience) *
Computer/tablet (Ability or Rating) *
Curriculum Implementation (Years of Experience) *
Curriculum Implementation (Ability or Rating) *

Employment History

List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment.

NA - Employment 1

NA - Employment 2


High School/ GED Equivalent

Graduated *

Graduated *
Other Training/ Education

NA - Other Training
Graduated *


Are you willing to willing to submit to a background check? *
Do you have any convictions or arrests that would prevent you from working in childcare? *


I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize Imagine Early Education and Childcare to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its owner, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Imagine Early Education and Childcare, except in a specific written contract of employment signed on behalf of the organization by its owner, has the power to alter or vary the voluntary nature of the employment relationship.