Early Childhood Educator Application Complete the following application to become a day home Educator. Step 1 of 5 20% Name* First Last Are you over 18 years of age?*YesNoEmail* Home Phone*Alternate PhoneAddress* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Name of CommunityWhat type of home do you live in?*Select OneHouseDuplexTownhouseApartmentDo you have a fenced yard?*Select OneYesNoDo you or anyone in your home smoke?*Select OneYesNoWhat are the closest schools to you?SeparatePublicWhat ages of children would you prefer to care for?* Are you currently employed?*Select OneNoYes, Full TimeYes, Part TimeIf yes, where are you currently employed?*Are you on social assistance?*Select OneYesNo Monday Start Time* : HH MM AM PM Monday End Time* : HH MM AM PM Tuesday Start Time* : HH MM AM PM Tuesday End Time* : HH MM AM PM Wednesday Start Time* : HH MM AM PM Wednesday End Time* : HH MM AM PM Thursday Start Time* : HH MM AM PM Thursday End Time* : HH MM AM PM Friday Start Time* : HH MM AM PM Friday End Time* : HH MM AM PM Would you be available for evening care?*Select OneYesNoIf married, is your spouse employed?*Select OneYesNoIf Yes, please indicate what shifts he/she works*Do you have any children?*Select OneYesNoIf Yes, please list all children: name and date of birth (yyyy/mm/dd)*Do you have any pets?*Select OneYesNoPlease list all pets*Why are you interested in joining a family day home agency?*Have you applied to and/or worked with another day home agency?*Select OneYesNo Do you have any work experience in childcare?*Select OneYesNoWhat sort of activities would you plan with the children?*Do you have first aid?*Select OneYesNoCould you provide 3 childcare references if needed?*Select OneYesNoDo you own any equipment (crib / highchair / stroller)?*Select OneYesNoHow did you hear about us?*Select OneNorthalta WebsiteGovernment WebsiteGoogle SearchSocial Media (Facebook)Northalta Window SignPhone BookFriend/RelativeFlyer or PosterOther (please specify)Other:*Any other relevant information you would like us to know?CommentsThis field is for validation purposes and should be left unchanged.