Educator s Application A de Educadoras
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1 Educator s Application A de Educadoras Name (Nombre): Address (Dirección): House Phone ( Teléfono): Cell (Correo Electrónico): Social Security # (Seguro Social): D.O.B (Fecha De Nacimiento): EEC License # (Licencia de EEC) Expiration (Expiración): Program#(Programa) License Capacity (Capacidad): PQR # QRIS LEVEL (Nivel de QRIS) First Aid Date CPR Date: Primary Language/ other (Idioma Primario/ otro): _ Please list all Household Members (Por favor Liste Todos los Mimbros del Hogar) Name (Nombre) D.O.B (Fecha de Nacimiento) Relationship (Relación) Any changes to household must be notified to VOC/EEC. (Todo cambio de mimbro del hogar debe ser notificada a V.O.C/EEC.) Do you have any pets, if so what kind? (Tiene usted alguna mascota? Cual? 1
2 Persons Available for Emergencies (Personas Disponible Para Emergencias) Name (Nombre) Address (Dirección) Telephone (Teléfono) WORK HISTORY (HISTORIAL DE TRABAJO): Employer(Empleador) Address (Dirección): Phone Number (Telefono): Supervisor(Supervisor): Job Title (Titulo De Trabajo): Duties &Responsibilities(Deberes y Responsabilidades Reason for Leaving (Razón de Partida): =================================================================== Employer(Empleador) Address (Dirección): Phone Number (Telefono): Supervisor(Supervisor): Job Title (Titulo De Trabajo): Duties &Responsibilities(Deberes y Responsabilidades Reason for Leaving (Razón de Partida): Education/Training (Educación/Entrenamiento) What is your level of education? (Check all that apply) Cual es su nivel de educación? (Señale todos los que apliquen) G.E.D High school (Escuela Secundaria) C.D.A Some College (Algun Colegio) Associates (Asociado) Bachelor (Bachillerato) Master (Maestría) What is your degree in?(en cuál es su título universitario?) 2
3 Experience (Experiencias) Have you ever cared for children on regular basis? ( Ha cuidado Niños regularmente? Yes (Si) No (No) Have you ever had 51- A supported? If yes, please explain: Se han reportado un 51 A u otras quejas contra usted? (Si respondió que si por favor explique): _ Will you be able to provide ten (10) hours of care for the children placed in your program? Usted podrá proveer 10 horas de cuido de niños en su programa? Will you be working with: ( Usted trabajará con) Regular Assistant Yes/ No Certified Assistant Yes/ No None (Asistente Regular) SI/No (Asistente Certificada) Si/No Ninguna What do you consider your strengths with regard to caring for children? ( Cual Considera usted que es su potencia en el cuido de niños?) What do you consider your weaknesses? ( Cual considera usted que es su debilidad?) Please give a sample of your daily schedule: (Por favor de ejemplo de su itinerario diario) 3
4 CORPORAL PUNISHMENT OF ANY KIND IS PROHIBITED IN FAMILY CHILDCARE (NINGUN CASTIGO ES PERMITIDO EN CUIDO DE NIÑOS FAMILIAR) What will you do when your method for the following differs from parents? Qué haría usted cuando los siguientes métodos difieren con los padres? Discipline: (Disciplina) Feeding children: (Dar de comer a el Niño (a) Potty training: (Entrenamiento del uso del baño) Describe how you would handle unacceptable behavior from a child: Describa como usted manejaría una situación de mal comportamiento en un niño (a): Are you with a Food Program? / Name of Food Program ( Esta usted con algún program de alimento?) / (Nombre el Programe de alimento) How would you respond to a parent whose preference regarding their child s eating habits were different from yours? ( Como usted le respondería a un padre cual sus hábitos alimenticios para su niño (s) son diferentes a los de usted? What would you do if a child would not eat? ( Que usted haría si un niño no comiera?) What would you do if a child was always hungry? ( Que usted haría si un niño (a) estuviera siempre con hambre? 4
5 Children in the Family Child Care Program come from a variety of ethnic, religious and economic backgrounds. How would you, as an Educator, make sure children feel welcome and safe in your program? (Los niños del programa del cuido familiar vienen de diferentes orígenes, religión y economía. Como usted como educadora les haría sentir bienvenidos(a) y seguros en su programa? How would you as an Educator make sure parents feel welcome and assured that their child/ren will received quality care in your program?( Como usted como educadora haria sentir bienbenido a un padre y asegurarce de que su niño (a) resivira un cuido de calidad en su programa? How would you handle a dissatisfied parent? ( Como usted manejaria a un padre insatisfecho? Do you own your home? Yes No Rent? Yes No (Usted tine casa propia?) Si No Renta? Si No Number of Floors? Number of room licensed? ( Cuantos Pisos?) Numeros de cuarto lisenciados? Type of home: Single Duplex Apartment Housing Development Tipo de casa: Una Familia Dos Familia Apartamento Vivienda 5
6 References: (Referencias) Name: (Nombre) Phone:(Tel.) Street (Calle) City(ciudad) State (Estado) Zip (Codigo) Name: (Nombre) Phone:(Tel.) Street (Calle) City(ciudad) State (Estado) Zip (Codigo) Name: (Nombre) Phone:(Tel.) Street (Calle) City(ciudad) State (Estado) Zip (Codigo) Liability Insurance:(Required) Seguro de Responsabilidad Civil (Requerido) Home: Name of Company: Policy Exp. Date: (Nombre de Compañía) (Exp de la Póliza) Car: (If Applicable) Carro (Si Aplica) If you are planning to transport children in care. (Si planificas transportar niños en tu cuido.) Name of Company Policy Exp. Date (Nombre de compañía) (Exp de la Póliza) 6
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