St. Landry Parish School Board

1) Date

2) Name:

3) Physical Address

4) Mailing Address (If different than Physical Address) (optional)

5) Preferred Phone Number (optional)

6) Email Address

7) Highest Level of Education (Higher Education/Degree is Not Required for Employment) (Ex. High School or College)

8) Are you working or have you worked in the past 60 days, (if applicable)?

Yes

No

9) If yes, list the following former employer information: Place of Employment, Position, Address, Phone Number (optional)

10) Have you worked with children and families before?

Yes

No

11) If yes, what type of setting have you worked with families in? (optional)

12) Are you Tech-savvy?

Yes

No

13) Do you have reliable transportation?

Yes

No

14) Is your child(ren) currently enrolled in SLP Early Childhood Network Programs?

Yes

No

15) If yes, what School/Childcare/HS Start site? (optional)

16) Special training, skills, or hobbies: (optional)

17) How did you learn about this employment opportunity? (optional)

District