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Early Years Employment Application

Complete all sections of this application and include any documentation requested.

Employment Application

Early Years Employment Application

Personal Data

Home Address
Home Address
City
State/Province
Zip/Postal
Previous Address
Previous Address
City
State/Province
Zip/Postal
Previous Address
Previous Address
City
State/Province
Zip/Postal
Previous Address
Previous Address
City
State/Province
Zip/Postal
Are you at least 18 years of age?
Other than a minor traffic offense, have you ever been convicted of a crime? This includes allegations of and/ or substantions of sexual or physical abuse and neglect of a child. (A conviction record will not necessarily bar you from employment.)
Are you legally eligible for employment in this country? (Proof of Eligibility will be required upon employment)
Have you ever applied with Early Years previously?
Have you ever received services from Early Years?
If YES, do you have any outstanding debts with Early Years?
Do you have any relatives presently employed with Early Years (formerly Child Care Services Association)?

Position

Please include desired dollar amount per month.
mm/dd/yyyy
Are you willing to travel?
If YES, any restrictions?
Are you willing to relocate?
Work Availability

Employment History

Present or Last Employer
May we contact your current employer for a reference? (Required)
2nd Previous Employer
May we contact for a reference?
3rd Previous Employer
May we contact for a reference?

Military Experience

Did you receive a dishonorable discharge?

Education

Additional Qualifications

Professional References

Name
Name
First Name
Last Name
Name
Name
First Name
Last Name
Name
Name
First Name
Last Name
APPLICANT CERTIFICATION:
The information contained in this application for employment with Early Years, Inc. (hereinafter, “The Agency”) is true to the best of my knowledge and belief.
1) I understand that any misrepresentation or false statement made by me in connection with the application or any related documents that are deemed material by The Agency shall result in The Agency not employing me or, if employed, terminating my employment.
2) I understand and agree that all information furnished in my application and any attachments may be verified by The Agency or its authorized representative. I hereby authorize all individuals and organizations named or referred to in my application and any law enforcement organization to give The Agency all information relative to such verification and hereby release such individuals, organizations, and The Agency from any and all liability for any claim or damage resulting therefrom.
3) I hereby acknowledge that I have been informed by The Agency that The Agency may seek to obtain a consumer report and/or investigative report that will include personal information regarding me, including but not limited to, educational history, work references, driving record and criminal convictions or arrest records if allowed, in order to assist The Agency in making certain employment decisions. I hereby consent to permit The Agency to conduct a search of state criminal history information and a fingerprint-based FBI check (if necessary) for selection and compliance purposes. I understand that selection into the program is contingent upon successful clearance of these checks and a search of the National Sex Offender Public Website. I understand that if I have been convicted of murder or if I am being required to be registered as a sex offender I am ineligible to work or serve in this position.
4) I further acknowledge notification by The Agency that reports may be provided to The Agency by other firms subcontracted for that purpose. I, my heirs, assigns and legal representatives, hereby release and fully discharge The Agency, its parent and affiliated companies and the respective officers, directors, shareholders, employees, agents of each, including subcontractors, from any and all claims, monetary or otherwise, that I may have against The Agency, its parent, affiliates or subcontractors, arising out of the making, or use of, either a consumer report and/or investigative report, including any errors or omissions contained or omitted from such reports or investigations. The Agency agrees to inform you if an employment decision has been influenced by information contained in a consumer report. The Agency will make available to you “A Summary of Your Rights Under The Fair Credit Reporting Act.
DISCLAIMER: This Employment application will be used solely to determine your qualification for employment with Early Years, Inc. (hereinafter “The Agency”). This document is not, or does not represent, a contract for employment. Please respond to ALL questions, providing complete information that is accurate to the best of your ability. False or misleading statements are grounds for refusal or termination of employment and benefits. It is the policy of The Agency to ensure that there shall be no discrimination against any employee or applicant for employment on the basis of race, ethnic/national origin, color, religion, gender, ancestry, age, physical disability, mental disability, medical condition, family-care status, veteran status, marital status or affectional orientation, or any other status protected by law, in accordance with the guidelines of the Equal Employment Opportunity Commission as well as the Fair Credit Reporting Act.