Teacher Application

MARYLAND STATE DEPARTMENT OF EDUCATION
Office of Child Care
INDIVIDUAL PERSONNEL INFORMATION

I am applying for: (check all that apply)
Aide Assistant Teacher (school age)
Teacher Infant/Toddler Preschool School age
Director Infant/Toddler Preschool School age
This form is to be completed by potential or new staff not previously evaluated or staff requesting re-evaluation. SEND THE COMPLETED FORM AND ALL SUPPORTING DOCUMENTATION TO THE OFFICE OF CHILD CARE REGIONAL OFFICE. THE EVALUATION WILL BE BASED SOLELY ON DOCUMENTATION SUBMITTED TO OCC.


No Yes *
No Yes *
No Yes *
Infant/Toddler School age School age Director
Infant/Toddler School age School age Director
No Yes, *
No Yes,   Name of School Major Degree Earned *
No Yes *
Provide information about your supervised experience working with groups of children in licensed child care centers, public/private schools, as a registered provider or other approved settings. Attach documentation from each employer, which states the number of hours worked, the ages of the children worked with, the position and the length of time worked.

Dates Worked

Name of Facility
(start with present employer)
Address and Phone # Supervisor Position Ages of Children # of Hours Worked Per Week

(mo)

(yr)

(mo)

(yr)

(mo)

(yr)

(mo)

(yr)

(mo)

(yr)

(mo)

(yr)

(mo)

(yr)

(mo)

(yr)
 
* Please remember to bring in all hard-copies of all your supporting documents