Change of Ownership Applicant Guide - Bright from the Start

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PLEASE LIST EMPLOYMENT HISTORY FOR THE PAST TEN YEARS, BEGINNING WITH YOUR MOST CURRENT OR LAST EMPLOYER. If you have been unemployed during any time within the past ten years, list how you spent your time, e.g. student, housewife, unemployed, etc. If you need addition space please use separate employment record form. MONTH/YEAR NAME AND ADDRESS OF EMPLOYER POSITION FROM TO FROM TO FROM TO FROM TO FROM TO Have you attended/completed any child care training courses? YES NO Do you have a criminal record? YES NO If yes, explain: Have you ever been shown by credible evidence, e.g., a court order or jury, a department’s investigation or other reliable evidence to have abused, neglected or deprived a child or adult or to have subjected any person to serious injury as a result of intentional or grossly negligent misconduct? YES NO Under the American with Disabilities Act of 1991, this program is required to reasonably accommodate individuals with a disability. The reasonable accommodation requirement applies to the application process, any pre-employment testing, interviews and actual employment, but only if the program supervisor is made aware that an accommodation is required. If you are disabled and require accommodation, you may request it at any time during the interview process. You are obligated to inform the program director of your needs if it will impact your ability to perform the job for which you are applying. Having read the job description for the position for which you are applying, are you in all respects, able to adequately perform the duties as described? YES NO If no, please explain. Do you have a valid driver’s license? YES NO If yes, give license number and class of license: Have you had CPR training within the past two years? YES NO If yes, give expiration date: Have you had first aid training within the past three years? YES NO If yes, give expiration date: Bright from the Start: Georgia Department of Early Care Learning requires annual child care training, are you willing to participate? YES NO I certify that all information on this application is correct. I have not given any false statement concerning my qualification requirements. SIGNATURE DATE
10 YEAR EMPLOYMENT HISTORY Name Address Social Security Number Record of Employment: Past 10 Years (If unemployed between 2 jobs/dates, write “no work”. Leave no gaps. Month/Year From: ________ To: _______ Name and Address of Employer Position Reason for Leaving From: ________ To: _______ From: ________ To: _______ From: ________ To: _______ From: ________ To: _______ From: ________ To: _______ From: ________ To: _______ From: ________ To: _______ From: ________ To: _______ From: ________ To: _______ From: ________ To: _______ From: ________ To: ________
Page 1 and 2:
Change of Ownership Licensing Appli
Page 3 and 4:
Section F: Operation Plan Operation
Page 5 and 6:
STEPS FOR SUCCESSFUL CHANGE OF OWNE
Page 7 and 8:
LICENSE FEE MUST BE SUBMITTED PRIOR
Page 9 and 10: BRIGHT FROM THE START: GEORGIA DEPA
Page 11 and 12: Exemptions Do you own any exempted
Page 13 and 14: License Number Bright from the Star
Page 15 and 16: INSTRUCTIONS FOR COMPLETING THE APP
Page 17 and 18: children you propose to serve (6 we
Page 19 and 20: Section C: Criminal Records Checks
Page 21 and 22: submit a new national fingerprint c
Page 23 and 24: BRIGHT FROM THE START Georgia Depar
Page 25 and 26: Section D: Floor Plan Sample Floor
Page 27 and 28: WINDOWS WINDOW SPACE REQUIREMENTS F
Page 29 and 30: MIXED-AGE GROUPS FOR CHILD CARE LEA
Page 31 and 32: CHILDREN’S STORAGE STORAGE SPACE/
Page 33 and 34: • If your facility plans to have
Page 36 and 37: GROUND COVERING ● Choose from a v
Page 38 and 39: PLAY EQUIPMENT AND SURFACES ● Pro
Page 40 and 41: FALL ZONE An area extending four fe
Page 42 and 43: (Merry-Go-Rounds, rotating teeter t
Page 44 and 45: Broken/missing steps/rungs/hand rai
Page 46 and 47: The Operation Plan Checklist has be
Page 48 and 49: EMPLOYEE FILES During your Initial
Page 50 and 51: __ 10. Handling emergency medical c
Page 52 and 53: Children's Files The following item
Page 54 and 55: Your menu should include clearly id
Page 56 and 57: Section G: SAMPLE FORMS
Page 58 and 59: Sample Staff Forms
Page 62 and 63: DOCUMENTATION OF ORIENTATION (Condu
Page 64 and 65: Additional Staff Policies & Procedu
Page 66 and 67: SAMPLE CHILDREN’S ENROLLMENT FORM
Page 68 and 69: Parental Agreements with Child Care
Page 70 and 71: INFANT FEEDING PLAN Child’s full
Page 72 and 73: REQUIRED REPORT OF INCIDENT Consult
Page 74 and 75: Food Service Forms
Page 78 and 79: Breakfast AM Snack Lunch PM Snack W
Page 80 and 81: Manual Dishwashing - Chemical Metho
Page 82 and 83: ITEMS TO BE POSTED
Page 84: PARENTS YOU HAVE THE RIGHT: 1. To a
Page 93 and 94: NOTICE TO PARENTS AND VISITORS: The
Page 95 and 96: TRANSPORTATION GUIDELINES To provid
Page 97 and 98: This is to certify that I give perm
Page 99: VEHICLE EMERGENCY MEDICAL INFORMATI
Page 108 and 109: Child Care Resource and Referral Ag
Page 111 and 112:
2 Martin Luther King Jr. Drive, SE
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