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Trinity Learning Center Inc.

46448 263rd St, Hartford, SD  57033

(605) 526-4021

General Information


Start Date

Are you presently employed?

May we contact your current employer?

Do you drive?

Do you have a valid driver's license?

Are you 18 years of age or older?


Did you graduate?

Please list:

  1. Names of Universities, Colleges, Business school     

  2. Location 

  3. Major/Specialization     

  4. Level or Degree     

  5. Dates Attended

Please list any additional experience, training, schooling, or special qualifications:

In caring for children, we believe it is our responsibility to seek staff members who are able to provide loving, safe and healthy relationships.

Have you ever received any kind of traffic ticket?

Have you ever been convicted of any felony?

Have you ever been investifated in connection with a charge of child abuse or neglect?

Have you ever been convicted of a crime involving either violence to persons or breech of moral conduct (i.e. rape, sexual molestation, incest, narcotics, etc.)?

Is there anything that would affect your work with children?

If you answered YES to any of the previous statements, please explain:

If you have been a student or adult leader in children's/students' ministry before, describe your responsibilities/tasks.

What talents or abilities do you possess that you would be willing to share with us as a part of our program?

What are your expectations of our early childhood program and staff?

Previous Employment

Name and Address of Employer

Begin Date Employed

End Date Employed

Name and Address of Employer

Begin Date Employed

End Date Employed

Name and Address of Employer

Begin Date Employed

End Date Employed


Please provide the names of three persons not related to you, who can serve as character references.  Please do not repeat names of supervisors furnished in employment record.

Check this box to indicate that:

I affirm that the information on this application form is true.  The center may contact my references and appropriate government agencies as deemed necessary to verify my suitability.

Today's date and time for staff use only.

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