First Name*
Last Name*
Email Address*
Phone*
May we contact you via text message?*
-- No answer -- YES NO
Are you a current or former Head Start or Early Head Start parent?*
-- No answer -- Yes No
Are you 18 years of age or older?*
-- No answer -- Yes No
If hired, can you furnish proof of eligibility to work in the United States?*
-- No answer -- Yes No
You will be required to furnish credentials to confirm your highest level of education, are you able to obtain documentation upon request?*
-- No answer -- Yes No
What is your highest level of education completed? Completed means you have obtained a degree.*
-- No answer -- I do not have a HS diploma High School/GED Associate's Degree Bachelor's Degree Master's Degree Doctorate Degree
Have you applied to TCHS before? If yes, when did you last apply to TCHS before?*
Have you worked at TCHS before? If yes, when did you work for TCHS, and in what position?*
Have you previously been offered a conditional offer of employment with TCHS and were unable to start employment? If so, when and why did you not start employment with TCHS at that time?*
Are you related to a current TCHS employee? If yes, who are you related to and what is the relationship?*
Date you can begin work?*
What skills or special training do you have related to the job you are applying for?*
Have you had any experience, either professional or non-professional, being around/working with children? Please tell us about that experience.*
Do you have any volunteer experience? If so, please list organization, type of volunteer work you did and for how long?*
Are you currently employed?*
YES NO
If yes, may we contact your current employer?
YES NO
Current Employer Name:
Current Employer Address:
Current Position Held:
Current Employer Start Date (Month & Year):
Current Employer Supervisor Name:
Current Supervisor Email Address:
Current Supervisor Phone Number:
Why do you want to leave your current place of employment?
Previous Employer 1 Name:*
Previous Employer 1 Address:*
Previous Employer 1 Position Held:*
Previous Employer 1 Start Date (Month & Year):*
Previous Employer 1 End Date (Month & Year):*
Previous Employer 1 Supervisor Name:*
Previous Employer 1 Supervisor Phone Number:*
Previous Employer 1 Supervisor Email Address:*
Previous Employer 1 Reason for Leaving:*
Previous Employer 2 Name:*
Previous Employer 2 Address:*
Previous Employer 2 Position Held:*
Previous Employer 2 Start Date (Month & Year):*
Previous Employer 2 End Date (Month & Year):*
Previous Employer 2 Supervisor Name:*
Previous Employer 2 Supervisor Phone Number:*
Previous Employer 2 Supervisor Email:*
Previous Employer 2 Reason for Leaving:*
Previous Employer 3 Name:*
Previous Employer 3 Address:*
Previous Employer 3 Position Held:*
Previous Employer 3 Start Date (Month & Year):*
Previous Employer 3 End Date (Month & Year):*
Previous Employer 3 Supervisor Name:*
Previous Employer 3 Supervisor Phone Number:*
Previous Employer 3 Supervisor Email Address:*
Previous Employer 3 Reason for Leaving:*
Please explain any gaps in your employment history. Also, please explain any short term employment less than 6 months.*
Have you ever been fired or asked to resign from a job? If you answered yes to the question, please explain.*
Please list at least three professional references not related to you, with full name, contact information, and email addresses.*
Did a current TCHS employee refer you to the position? If yes, tell us who referred you?*
How did you hear about this position? Select all that apply.*
TCHS Career page Indeed Facebook Through a friend Radio advertisement Newspaper advertisement Colorado Workforce Center Other
Background Check Requirement Notice
Durango 4-C Council/Tri-County Head Start is an equal opportunity employer and is required per Head Start Performance Standards 45 CFR 1302.90 and Colorado State Childcare Licensing to conduct a comprehensive background check that includes but is not limited to: 1) criminal history with a national electronic check, 2) sex offender registry check, 3) child abuse and neglect state registry check, and 4) criminal history with a fingerprint check (FBI/CBI/state/tribal). We encourage all qualified candidates to apply. TCHS will consider qualified applicants with a criminal history pursuant to federal and state regulations. Background checks will be completed following the extension of a conditional offer of employment, and adverse findings will require an individual assessment for consideration in relation to the safety and well-being of the children we serve. Are you willing to undergo a background check in accordance with TCHS policy, pursuant to childcare care regulations?*
-- No answer -- YES NO
Affidavit (Please read each statement carefully before signing)
I certify that all information provided in this employment application is accurate and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.
I authorize the investigation of any or all statements in this application and permit any person, school, current employer (except previously noted), past employers, and organizations named in this application to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.
I understand that if I am extended an offer of employment, it is contingent on completion of all employment requirements, according to the established schedule for completion, including but not limited to physical examination, background check, reference checks, Fingerprinting and TRAILS, tuberculosis testing, and other licensing requirements.
I understand that I may be required to pass a drug screen examination successfully. I hereby consent to a pre and/or post-employment drug screen as a condition of employment, if required.
I understand that this application or subsequent employment does not create a contract of employment nor guarantee employment for any definite period of time. If employed, I understand that I have been hired at-will according to Colorado state law, and my employment may be terminated by Durango 4-C Council, Inc/Tri-County Head Start or by myself at any time, with or without cause or with or without prior notice.
I have read, understand, and by my signature consent to these statements.
Type Name Below as your Signature:*
The following questions are entirely optional.
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Expires 04/30/2026
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