Interest Form - Become an Early Learning Substitute Educator (ELSE) for Building Blocks
In an effort to assist child care programs with substitute needs, Building Blocks has launched our ELSE program. If you are interested in working with children in a child care setting (ages 6 weeks to 5) or want to learn more about this opportunity, please complete the following form.
Name
*
First Name
Last Name
Email
*
example@example.com
Mailing address
County of residence
*
Phone Number
*
Are you at least 18 years old?
*
Yes
No
Please enter your date of birth
*
-
Month
-
Day
Year
Date
Which of the following age groups are you interested in working with? Check all that apply.
*
Infants
Toddlers
Pre-K (3-5)
Have you received a criminal background check in the last three years? - The state of Indiana requires a criminal background check to be conducted on all child care staff members (including prospective staff members) who are employed by child care providers. Learn more at: https://secure.in.gov/fssa/carefinder/background-check-requirements/
*
Yes
No
Have you received CPR certification within the last year?
*
Yes
No
Have you received First Aid certification within the last year?
*
Yes
No
Have you received a physical exam within the last six months?
*
Yes
No
Indiana law requires that individuals pass a drug screen before they can work in a child care program. Do you have any issues with this request?
*
Yes
No
Do you have dependable transportation?
*
Yes
No
Reference #1 (include the person's name, title, workplace, phone, and email).
*
Reference #2 (include the person's name, title, workplace, phone, and email).
*
Reference #3 (include the person's name, title, workplace, phone, and email).
*
My highest education level is:
*
High School or equivalency
Some college
Associate's Degree
Bachelor's Degree
Master's Degree
Doctorate
None of the above
List weekly availability starting August 1, 2024
*
Monday
Tuesday
Wednesday
Thursday
Friday
Full-time
Part-time
I have a current resume and will submit upon request
*
Yes
No
How did you hear about the Building Blocks ELSE program?
Have you ever been arrested for or convicted of a crime that has not been expunged by a court? If yes, please explain.
I confirm all information included on this form is accurate and valid. I give permission for my information to be shared with child care providers, I understand that Building Blocks through its ELSE program is collecting information that will be provided to those hiring child care substitute educators. Building Blocks is not responsible for vetting or hiring child care staff. Once information is exchanged, you and potential child care program/organization will agree upon work hours and terms of employment.
*
Yes
No
Submit
Should be Empty: