Two week Resignation Form

During your course of employment with For the Love of Children we expect to be given a 2 week notice, should you decide to quit. If you quit without a 2-week notice, your last paycheck wifi be at the minimum wage rate of pay. This and another correspondence with our Learning Center will be mailed to you.

Employee's Signature

Director's Signature

Authorization

I certify that all the information that I have listed above is true and complete to the best of my knowledge and that if employed, falsified statements on this application shall be grounds for dismissal. 1 understand that the job I am applying for is a set position & has set hours, however that position & hours are subject to change due to child/staff ratio's or staff changes.

.1 understand that I will be given a Three (3) week period to perform my job at the level that I was hired for.. If I do not meet that level of performance in my job in that time period, my position will be terminated.

Employee's Sign

For the Love of Children .3700S

9

Westport Ave. Sioux.Falls, SD 57106

"NEW HIRE REPORTING FORM"

EMPLOYEE NAME:

ADDRESS:

CITY, STATE, ZIP CODE:

SOCIAL SECURITY NUMBER

EMPLOYER NAME: For The Love of Children

ADDRESS: 3700 S WESTPORT AVE SIOUX FALLS, SD 57106

FEDERAL ID #: 46-0447554

CHILD. ABUSE POLICY

South Dakota Law (SDCL26-lO-1O) mandates all licensed or registered child care providers to report any suspected incident of child abuse or neglect to the Department of Social Services or Law Enforcement. Reportable incidents include suspected abuse/neglect within this group care center.

REPORTING POLICY

Any staff member or volunteer who feels that a child in placement may have been abused or neglected at home or in this center is to immediately report her/his feelings to the director or to the individual who is designated as the supervisor. After verbally reporting the incident to the director or her designee, the employee/volunteer is to document in writing what she/he observed. This report is to include the date of the incident, time, those involved, and a statement of what was observed. This written report is to be given to the director or her designee. Upon receiving the verbal report the director/designee is to immediately: .

I. Report the incident to the Deparment of Social Services or law enforcement.

2. In case of in-center child abuse, the staff member/volunteer will be terminated immediately.

3. In case of suspected in-house child abuse/neglect, determine if the children are safe pending the investigation. If a staff member/volunteer is involved, suspension. may occur to protect children.

4. Cooperate with the Department of Social Services and/or law enforcement throughout the investigation.

Signature Date

To be filled out by employer

For the Love of Children

1.) Tell us about yourself? Any schooling, training, hobbies, family, pet or sports?

2.) What are three positive qualities about yourself or your work habits?

3 .)Have many days of work have you missed in your last year of employment or in school?

4.) What kind of position are you applying for? Is this ajob you plan on keeping for at least one year?

5.)Jlow would you help a child that is having separation. anxiety from their parents/guardian when getting dropped off?

6.)What kind of activities would you do with the children?

7.)How would you handle a situation where a child has hit or bit over a toy?

8) What would you do with a defiant child that was' trying to hit, kick, :spit, or bite you?

9.) How would you let a parent know that a child has not had a good listening day?

10.) Would you find it difficult to work in a different room? Can you take your breaks at different times during the week?

11.) Do you have a reliable meats of transportation to & from work? Would you be able to drive a daycare van with kids for fleldttips or school runs?

DSS CP-593 07/14

INSTRUCTION FOR COMPLETING PERMISSION FORM

1. Each applicant and all other required personage 10 years or older must complete and sign a

Permission to Screen for Reports of Abuse or Neglect form.

2. From choices listed, mark correct o box to indicate the appropriate facility/provider type.

3. Liston the first blank line of this form, the type of license or registration or employment position for

which you have applied (this will vary for each person). Examples are, but are not limited to:

Family Day Care applicant Adoption Applicant Child to Applicant Teacher Facility Director

Facility/Program Administrator Foster Care Applicant Site Assistant Volunteer Facility Driver

Secondary Child Care Worker Spouse of Applicant Site Coordinator Facility Cook GFDC Operator

Other household member Youth Care worker

4. List your full name on the appropriate line. This would he your current legal first, middle, and last

name. The listing of your date of birth must include the month, day and year you were born.

5. List your maiden name on the appropriate line. If this section does not apply to you, write N/A (meaning

not applicable) in this area.

6. List any other names you have used on the appropriate line. Examples of such name would be

nicknames; any abbreviated versions of your full name (i.e., William/Bob or Edward/Ed); previously married

names; a birth name; or any other names that have been used.

7. List your social security number, V' or ic appropriate Male/Female blank, and list your race.

8. List all addresses from any place you have lived SINCE BIRTH on the appropriate lines. All information is

important, but if you are not able to remember the complete address for a previous living location, you

must always include the City and State. Always include the Beginning and Ending Dates for each

address location (Use your best judgment if you cannot remember exact dates & write down the year {2001-20101).

9. List the full name and date of birth for all of your own children (even if the children do not live with you now).

Do not list the names of other people's children for whom you provide care (i.e., daycare children, children

in foster care).

10. SIGN your name at the bottom of the form. If the screening is for a person under 18 year of age, this

person's parent or legal guardian must sign the form. Include your current maiflng address at the

bottom of the form.

11. Complete the Agency Information by listing the agency's name as it appears on their license, agency

complete mailing address and telephone number, and the agency's license number as it appears on

their license. If the agency has applied for a licensed but has not yet received its beginning license,

mark where indicated.

12. Return your completed permission form to the appropriate agency.

If any information is found that would prohibit the issuance of a child welfare license or registration or

prohibit employment with a licensed or registered child welfare agency, the individual will be notified of the

screening results and be informed of their right to request a hearing on the matter if they have not received

previous. noticed Once proper notification has been accomplished, the Department will notify the licensed or

registered agency of the screening results.

FAILURE TO LIST ALL INFORMATION OR COMPLETE ALL QUESTIONS WILL DELAY THE SCREENING PROCESS.

055 CP-593 07/14

LI Relative/Other Caretaker (DOC)

LI Relative Placement (CPS)

El Tribal Child Welfare

Check ONE box that

corresponds with the

facility type for this

request.

LI Adoption

LI Before & After School Center

LI Child Placement Agency

LI Foster Home

Li Group/Residential Facility

El Head Start Program

LI Independent Living Prep Program

LI In Process Regulated Child Care

El Maternity Home

LI Regulated Child Care Program

(Please read instruction on back of this form before completing)

PERMISSION TO SCREEN FOR REPORTS OF ABUSE OR NEGLECT

In connection with my application/approval, as a(n) I understand that my

name must be screened for substantiated reports of abuse or neglect in South Dakota and any other states in which 1 have resided

since birth. My signature authorizes that South Dakota Department of Social Services, and any other state, to search any information

systems and any central registry for child abuse and neglect they may have, and review records, identified in the search which may

provide information related to reports and investigations of abuse or neglect. My signature authorizes the release of any

information found in theses searches, including but not limited to substantiated incidents not on the central registry of child abuse

and neglect, to the South Dakota Department of Social Services.

Full Legal Name:

Date of Birth: Maiden Name:

Other Names Used:

Social Security #: Male: Female: Race:

List All Prior Address: (Since birth in chronological order with birthplace first)

Street Address City Coun

State Dates

List Full Name (First, Last, birth) and Date of Birth of ALL of your OWN Children:

(Do not list other people's children for whom you might provide daycare)

Name Date of Birth Name

Date of Birth

The Department of Social Services, it's staff and agents are released from any and all liability based upon information transmitted

through this authorization, as long as such information is given in good faith.

My Signature further authorizes the release of any information found in these searches, including but not limited to substantiated

incidents not on the central registry of child abuse and neglect, to the agency listed below.

Signed:

Address:

Agency Name & Phone Number

Agency Mailing Address Agency License Number

) N/A —oSsfiel&fficeJHead Start

N/A— License not yet issued

Date: