Bridge the Gap the Fun Way with Music, Sign Language, and Play!




APPLICATION FOR BABY SING & SIGN LICENSURE



By filling out and submitting this application, you agree that we may rely upon the information provided herein. Upon completion of this application, you will have the opportunity to purchase the licensure training kit.


GENERAL INFORMATION
First Name: Last Name:
Address:
 
City/State/Zip:
Country:
Start Date (MM/DD/YYYY):
Email Address: Confirm Email Address:
Current Home Phone: Current Mobile Phone:
Current Work Phone: Gender:
Date of Birth (MM/DD/YYYY):
US Citizen?: If no, Where is your Citzenship?:
If you were referred to our program by a friend or colleague, please provide the name and email address for this individual:
Baby Sing & Sign T-shirt size (please choose one):

EMPLOYMENT INFORMATION
Current Title: Current Company/Organization:
Supervisor and their Phone Number: Start/End Day (MM/DD/YYYY): Start
End
Address: City/State/Zip:
  Country:
Responsibilities:

BACKGROUND INFORMATION
Have you or your spouse (if married) ever been convicted of a crime?:
If Yes, please explain:
Are you or your spouse (if married) currently under investigation or pending charge?:
If Yes, please explain:
Have you or your spouse (if married) ever been involved in any law suits or legal action?:
If Yes, please explain:
Have you or your spouse (if married ever filed bankruptcy of any kind?:
If Yes, please explain:

EDUCATIONAL ACHIEVEMENT
List the college degree(s) you hold, granting institution(s), years attended (from and to), and year graduated:

PROFESSIONAL LICENSING AND CERTIFICATIONS
Have you or your spouse (if married) ever received licensure from another business venture serving children? :
Are you or your spouse (if married) currently licensed by another business venture serving children? :
List all educational and professional licenses and certifications you past and current hold that are relevant to your skills and expertise as a candidate for Baby Sing & Sign licensure:
Have you or your spouse (if married) ever been sanctioned or had your license suspended or revoked? :
If Yes, please explain:
To verify this is a real person filling out this online form please answer the following question:
What day comes before Monday? (Hint: Sunday):

CONFIDENTIALITY AGREEMENT - (Please Enter Your Name in Boxes)

By applying for Baby Sing & Sign licensure, you are entering into a reciprocal and confidential relationship, where licensor (Sing & Sign Resources LLC) and (applicant/instructor) honor strict confidentiality practices pertaining to all information shared on this application and/or during the course of licensure. This applies to any and all information exchanged between both parties, including but not restricted to the application, published materials, email correspondences, and phone conversations. Sing & Sign Resources, LLC agrees to maintain and restrict the use of this information in connection with application for Baby Sing & Sign licensure. Information solicited from (applicant/instructor) solely for the purpose of the application will not be shared with any other individuals or organizations outside of Sing & Sign Resources LLC. (applicant/instructor) agrees not to copy any documents, or in any manner duplicate any information contained in any and all Baby Sing & Sign materials, including but not limited to licensure contract, training manual, DVD, or email correspondence. This agreement will remain in full force and effect at all times and will survive the termination of any contract between Sing & Sign Resources LLC and (applicant/instructor) or the termination of employment of any employee that has access to the computer files or other information described above.

AUTHORIZATION FOR RELEASE OF PERSONAL INFORMATION

By clicking submit I authorize Sing & Sign Resources, LLC to verify any and all data submitted.
Date of Birth: Today's Date:
After submitting your application you will be directed to the payment page to purchase your Baby Sing & Sign Licensure Training Kit.






 

 

Copyright © 2008 by Sing & Sign Resources, LLC.