List all your addresses for the past five years:
Have you ever applied for a child day care license in Connecticut or in any other  state? If yes, when and where?
Have you ever held a child day care license in Connecticut or in any other state? If yes, when  and where?
Have you ever applied for a foster care or adoption license in Connecticut or in any other  state? If yes, when and where?
Have you ever been licensed for foster care or adoption in Connecticut or in any other state? If yes, when and where?
Have you ever been employed at a licensed child care facility? If yes, when and where?
Have you or any person living in your home ever been convicted of any crime in Connecticut or any other state? If yes, please indicate when, where and what the conviction(s) was:
Are you currently employed outside of home? If yes, describe the job and your hours of  employment:
Do you plan to continue outside employment after you are licensed/approved? If yes, please explain:
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