First Name Stellar Academy Employment Questionnaire Last Name * Address 1 * City Address 2 State Zip Email Address If part time, when are you available? None AM PM All Day Monday Tuesday None AM PM All Day Day Phone Evening Phone Do you need healthcare coverage No Yes Do you need child care for your children No Yes If Yes, enter ages of Child 1 Child 3 Child 2 Start Date Full or Part time Full Part If not Full Time, hours per week Wednesday None AM PM All Day Thursday None AM PM All Day None AM PM All Day Positions - Please rank in order of preference (0=none 4=most) Infant Teacher (6 wks-12mos) Toddler (12-24 mos) Care Giver (+24 mos)(nurture/care for physical/emotional health of child) Teaching Specialist (+24 mos)(develop/deliver "developmentally appropriate programs") Teaching Specialists: Please indicate in which zones you are interested in teaching: No Yes Discovery Zone (science/nature) No Yes Carnegie Hall (music/singing) No Yes Alphabet Soup (reading/writing) No Yes Me, Myself & I (self awareness) No Yes NASA (number sense) No Yes The Louvre (visual arts) No Yes The Olympics (dance/sport) No Yes The UN (careers/cooperation) Comments on your qualifications/talents (200 characters max) * Please fill out the form and press 'Submit Questionnaire' button when finished. This will be sent to our Staff Development Director and she will contact you for a follow up if a position is available. Thank you for your interest in Stellar Academy!