ABCCA Online Employment Application | ABC Children's Academy

Employment Application (Rev. 08/22)

Please answer each question fully and accurately. No action can be taken on this application until all questions have been answered.

Full Name *

First

Middle

Last

Date of Application: *

Date

Time

Complete Address: *

Address Line 1

Address Line 2

City

State

Zip Code

1st Contact Number: *

2nd Contact Number:

Email: *

Are you at least 18 years of age? *

Position Applying For: *

Pay Desired: *

Date available to start working: *

Do you want to work: *

Full Time
Part Time

Referred by:

Please fill in the hours each day that you are available to work:

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Have you ever worked for ABC Children’s Academy before?

If Yes, please list dates of employment and location(s) worked:

Do you have a checking account for Direct Deposit of your Paycheck?

Has a court ever denied you parent custodial or visitation rights due to child neglect or maltreatment?

If Yes, explain:

Have you ever been convicted or have charges pending of a criminal offense of any kind?

If Yes, explain:

Do you have any limitations that would restrict job performance or that would put children at risk?

If Yes, explain:

Do you acknowledge that the use of marijuana either medically or recreationally while working in a childcare is not allowed according to Article 98 of the Arkansas Constitution?

Would you take a physical examination if required?

Are you now or have you ever used illegal drugs?

Would you be willing to take a drug screening?

Are you or your spouse a registered sex offender?

Are you now or do you expect to be engaged in other business or employment?

If Yes, explain:

Educational History

Please list your most recent three sources of education

School #1

Type of School *

Name of School *

City & State *

Major *

Years Completed *

Date & Degree Earned *

School #2

Type of School

Name of School

City & State

Major

Years Completed

Date & Degree Earned

School #3

Type of School

Name of School

City & State

Major

Years Completed

Date & Degree Earned

References

Name, complete addresses, and phone numbers of the people we may contact about you. No relatives or former employers, please.

Reference #1

Name *

First

Last

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Reference #2

Name *

First

Last

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Reference #3

Name

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Employment History

List your last 6 years of employment: employers, assignments, or volunteer activities, starting with your CURRENT or most recent employer, including military experience.

Employer #1

Employers Name *

Employed From & To dates *

Duties *

Supervisors Name & Phone *

Reason for Leaving *

Employer #2

Employers Name

Employed From & To dates

Duties

Supervisors Name & Phone

Reason for Leaving

Employer #3

Employers Name

Employed From & To dates

Duties

Supervisors Name & Phone

Reason for Leaving

Emergency Contact

Name, Complete Address, home & work phone numbers of the person we may call in case of an emergency:

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone *

Work Phone *

AFFIDAVIT:

AFFIDAVIT: I CERTIFY THAT EVERYTHING IN THIS APPLICATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT MISLEADING OR INCORRECT STATEMENTS OR CONSEQUENTIAL OMMISSIONS MAY RENDER THIS APPLICATION VOID, OR IF EMPLOYED, WOULD BE CAUSE FOR TERMINATION. I AUTHORIZE THE INDIVIDUALS OR INSTITUTION RELEASING THEM FROM ALL LIABILITY FOR ISSUING SUCH INFORMATION.

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Employment Application

Employment Application (Rev. 08/22)

Educational History

References

Employment History

Emergency Contact

AFFIDAVIT:

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