Position Applying For:
Center Director
Lead Teacher
Assistant Teacher
Part time Teacher
Sign Language Teacher
Yoga Teacher
Spanish Teacher
Food and Nutrition Specialist
Janitor/Light Maintenance Technician
Preferred Location
LMLC Batavia
LMLC Belvidere
LMLC Bloomington
LMLC Champaign
LMLC Crystal Lake
LMLC Decatur
LMLC Elkhorn
LMLC Gurnee
LMLC Holmen
LMLC Hudson
LMLC Kankakee
LMLC Lake In the Hills
LMLC Montgomery
LMLC Naperville
LMLC North Chicago
LMLC Oakdale
LMLC O'Fallon
LMLC Onalaska
LMLC Orland Park
LMLC Peoria
LMLC River Falls
LMLC Rockford North
LMLC Rockford South
LMLC Springfield East
LMLC Springfield West
LMLC Management
Name:
Current Address:
City:
State:
MI
WI
IA
IL
IN
NE
CO
WY
TX
NC
ND
SC
SD
NV
CA
WA
MI
OH
NY
FL
TN
AR
MS
AL
OK
KS
NM
AZ
ID
MT
OR
KY
RI
MA
ME
DE
VA
Home Phone Number:
Other Contact Number:
Email Address:
Social Security Number:
###-##-####
On What Date, would you be available to work?
Are you a US Citizen or are you authorized to work in the Us without any restrictions?
Yes
No
Have you been convicted of a felony?
No
Yes
If yes, please explain the circumstances:
Have you ever been Involuntarily Terminated or asked to resign from any position of employment?
No
Yes
If yes, please explain the circumstances:
If selected for employment, are you willing to submit to a Pre-Employment Drug Screening Test?
Yes
No
Most Recent School:
Education
Location:
Years Attended:
Degree Received:
Major:
School Name:
Location:
Years Attended:
Degree Received:
Major:
School Name:
Location:
Years Attended:
Degree Received:
Major:
Other Training, Certifications or Licenses Held:
List other Information Pertinent to the Employment You are Seeking:
1st Employer:
Employment (Most Recent First)
Job Title:
Dates Employed:
Address:
City/State:
Zip:
Supervisor's Name:
Phone Number:
Starting Salary:
Ending Salary:
Duties Performed:
Reason for Leaving:
2nd Employer:
Job Title:
Dates Employed:
Address:
City/State:
Zip:
Supervisor's Name:
Phone Number:
Starting Salary:
Ending Salary:
Duties Performed:
Reason for Leaving:
3rd Employer:
Job Title:
Dates Employed:
Address:
City/State:
Zip:
Supervisor's Name:
Phone Number:
Starting Salary:
Ending Salary:
Duties Performed:
Reason for Leaving:
Part Time Staff Only:
Hours Available to work:
Mon AM
Mon PM
Tues AM
Tues PM
Wed AM
Wed PM
Thur AM
Thur PM
Fri AM
Fri PM
Sat AM
Sat PM
Hourly Desired Rate:
Signature of Applicant:
Please fill out with your full legal name:
Date:
Date applied:
Reference One:
Print Name
Phone Number:
Relationship:
Reference Two:
Print Name:
Phone Number:
Relationship:
Reference Three:
Print Name:
Phone Number:
Relationship:
Attach Resume
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