For office use only
1785 Eldron Boulevard
Palm Bay, FL 32909
(321)-723-8884
Fax (321)-723-8872
Date Called:
Result:
1st interview:
Result:
2nd interview:
Result:
Date of hire if applicable:
Rate of pay if
applicable:
www.pineapplecoveacademy.com
Employment Application
Instructions: All information on this application must be truthful and correct. Falsification or
misrepresentation on the applications is cause for immediate dismissal.
PLEASE PRINT
Name:
Date:
_______________________________________________________________________
Last
Address:
First
Middle
________________________________________________________________________
Street
City
State
Zip
Telephone: Home ____________________Work ___________________ E-mail Address___________
Position Applying For: ___________________________________________________Part Time
Full Time
NOTE: In general, candidates are hired at the entry rate for the position. If you are unable to
accept the entry rate, please indicate the minimum rate you are willing to consider:
$ ____________________ Per hour
Emergency Contact Information:
Name
_____________________________________________________________________
Relationship
_____________________________________________________________________
Address
_____________________________________________________________________
Phone Number _____________________________________________________________________
Please answer the following questions:
1. Have you ever held a child care license with the Department of Children and Families or been registered
to provide child care in your home?
___Yes
___No
2. What do you like most about working in a child care facility?
Explain:_______________________________________________________________________________
______________________________________________________________________________________
3. While employed in a child care program, have you ever been the subject of disciplinary action, or been
the part responsible for a child care facility receiving an administrative fine or other disciplinary action?
___Yes
___No
If yes, please explain: ________________________________________________________________
4. In ten words or less, describe your philosophy regarding early childhood education.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
5. Do you have your 40 hours of DCF training? ______________
6. Have you lived in a different state in the past 5 years? If yes, then please
list:___________________________________________________________________________________
______________________________________________________________________________________
7. Do you hold a FCCPC (Florida Child Care Professional Certificate)? _______________
8. Briefly describe how you have decided to apply for employment at Pineapple Cove Academy.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Education and Training
Highest Grade Completed: __________
Did you graduate?  Yes _____/_____
month year
 No
Colleges Attended
City and State
Major
Field
Do you have a High School Equivalency Diploma (GED):
 Yes ___________ ______________
year awarded
state awarded
 No
No. of
Credits
Degree
Awarded
Dates Attended
From
To
Child care training courses
Training Courses Taken
Hours
Date of Completion
Please either drop application off at Pineapple Cove Academy Mailbox, OR Email:
[email protected] or fax 321-723-8872
Employment History
Present or Most Recent Position:
May we contact your present employer about you?  Yes  No
Employer Name
Dates of
Employment
______________________
Month/Year
Address
From: ____/_____
_____________________________
To: ____/_____
Salary
Start $
_____
Average
Hrs. Per
Week
_________
_________
Final $
_____
OFFICE
USE ONLY
Date Called:
__________
Time:_____
Who I
Spoke to:
__________
_____________________________
Job Title
_____________________________
Telephone _____-__________ Name and Title of Supervisor ___________________________________
Reason for Leaving ______________________________________________________________________
Duties_________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Former Employer
Employer Name
______________________
Dates of
Employment
Month/Year
Address
From: ____/_____
_____________________________
To: ____/_____
_____________________________
Job Title
Salary
Start $
_____
Final $
_____
Average
Hrs. Per
Week
_________
_________
OFFICE
USE ONLY
Date Called:
__________
Time:_____
Who I
Spoke to:
__________
_____________________________
Telephone _____-__________ Name and Title of Supervisor ___________________________________
Reason for Leaving ______________________________________________________________________
Duties_________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Former Employer
Employer Name
______________________
Dates of
Employment
Month/Year
Address
From: ____/_____
_____________________________
To: ____/_____
Salary
Start $
_____
Final $
_____
Average
Hrs. Per
Week
_________
_________
OFFICE
USE ONLY
Date Called:
__________
Time:_____
Who I
Spoke to:
__________
_____________________________
Job Title
_____________________________
Telephone _____-__________ Name and Title of Supervisor ___________________________________
Reason for Leaving ______________________________________________________________________
Duties_________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
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