Main Street Children’s Academy

6320 Main Street, Williamsville

Application for Employment

Position applying for______

Date available______Full time/Part time

Availability______

Date:______

Name:______

LASTFIRSTMIDDLE INITIAL

Address: ______

City:______State:______Zip:______

Home Phone: ______Social Security #:______

Are you a US citizen? ____yes ____no. If not, are you authorized to work in the US? ____yes ____no

Have you ever been convicted of a crime? ____yes ____no If yes please describe:______

Have you ever been treated for mental health disturbances? If yes please explain______

EDUCATION
Name / Location / Graduate? / Degree / Date
High School
College
Graduate
Other
EMPLOYMENT (begin with most recent)

Job Title______Dates employed_____to____

Employer______Pay scale ______

Address______

Duties ______

Supervisor/Title______Phone______

Reason for leaving______

May we contact your present employer? ___ If no, why?______

______

Job Title______Dates employed_____to____

Employer______Pay scale ______

Address______

Duties ______

Supervisor/Title______Phone______

Reason for leaving______

Job Title______Dates employed_____to____

Employer______Pay scale ______

Address______

Duties ______

Supervisor/Title______Phone______

Reason for leaving______

Special Skills/Training ______

______

Hobbies/Interests ______

______

REFERENCES

Please list three people who are familiar with your background and qualifications. Do not use relatives and friends.

NameAddress Occupation Telephone

1.______

2.______

3.______

I hereby authorized investigation of the above information. I understand that any misrepresentation or omission of information called for on this application will be sufficient cause for cancellation of further consideration of employment of immediate dismissal if I have been employed. The quotation or payment of salary on a weekly, monthly or yearly basis shall not constitute or be construed as a contract for employment for any period of time . It is understood that employment hereunder, if offered and accepted, is at will of employee and Main Street Children’s Academy.

I further understand that before I am eligible for employment, I must pass a physical by my physician and be cleared by the NYS Central Clearance Registry.

I attest the above information is true to the best to the best of my knowledge.

______

Signature Date

Please answer the following:

1. Please describe the skills you possess to prepare you for this job:

2. Please define “professional conduct” and how it relates to a child care program:

3. Complete this sentence: “A teacher is…”