Child First Authority, Inc.

An Equal Opportunity Employer

Application for Employment

Please print

First Name & Middle Initial Last Name / Date
Street Address / Home Phone
City, State, Zip Code / Daytime Phone
Position Applying For / Type of Employment Desired
o Full Time
o Part Time
E-mail Address / Have you had a criminal background check by BCPSS?
o Yes
o No
Have you ever been employed by the Child First Authority?
o Yes: give dates ______
o No / Social Security Number
Date of Birth
Are you legally eligible for employment in the United States?
o Yes (Proof of citizenship or immigration status will be required upon employment in
o No order to comply with the 1986 Immigration Reform and Control Act. Certain
positions require U.S. Citizenship in order to obtain security clearance.) / When are you available to begin work?
Indicate Referral Source:
o Advertisement o Referral o Government Agency o Resume
o BCPSS employee:
Emergency Contact (s)
Name______Phone Number______
Name______Phone Number______
Applicant: Please Do Not Write in This Box (Child First Office ONLY)
Job Title Job Code
Location Supervisor
Status o Regular Full Time o Regular Part Time (Scheduled Weekly Hours ______)
Salary Rate Start Date
Approved By Date
Employment History / Please complete even if you have provided a resume. List the last four (4) employers, assignments, or volunteer activities, starting with the most current. Provide additional data on a separate sheet, if you wish.
Employer Telephone / Job Title
Address / Dates Employed (mm/yy)
From ______To ______
Immediate Supervisor’s Name and Title Telephone / Starting Salary
Summarize Job Duties and Responsibilities / Final Salary
May we contact for reference? o Yes o No / Reason For Leaving
Employer Telephone / Job Title
Address / Dates Employed (mm/yy)
From ______To ______
Immediate Supervisor’s Name and Title Telephone / Starting Salary
Summarize Job Duties and Responsibilities / Final Salary
May we contact for reference? o Yes o No / Reason For Leaving
Employer Telephone / Job Title
Address / Dates Employed (mm/yy)
From ______To ______
Immediate Supervisor’s Name and Title Telephone / Starting Salary
Summarize Job Duties and Responsibilities / Final Salary
May we contact for reference? o Yes o No / Reason For Leaving
Employer Telephone / Job Title
Address / Dates Employed (mm/yy)
From ______To ______
Immediate Supervisor’s Name and Title Telephone / Starting Salary
Summarize Job Duties and Responsibilities / Final Salary
May we contact for reference? o Yes o No / Reason For Leaving
Type of School / Name and Location of School / Years Completed / Major Course of Study
High School / 9 10 11 12 / Graduated? o Yes o No
Undergraduate
College(s)/University / 1 2 3 4+ / Undergraduate
Degree Received:
Major:
Minor:
Graduate
College(s)/University / 1 2 3 4+ / Graduate
Degree Received:
Major:
Minor:
Technical/Vocational
School / Graduated? o Yes o No
Major:

Education

Are you a certified teacher? Yes No

Additional Data

List all relevant training and experience (include any professional license or certifications received)
Complete this section if you served in the U.S. Armed Forces
Describe your duties and special training:
/ Branch of Service
From To
Rank at Discharge
Date of Final Discharge
Have you ever been discharged or forced to resign from any position? o Yes o No
If yes, give details:
Explain any gaps in employment
Have you ever been convicted of, or pleaded guilty to a crime, whether before a court or by military court martial? Do not include arrests without convictions, convictions adjudged “youthful offender,” or conviction for speeding, minor traffic violations or matters that have been expunged. Conviction of a criminal offense does not automatically bar a person from employment with Child First Authority, Inc., or any subsidiary or affiliate. Factors such as federal, state or local statutory requirements, the relationship of the offense to employment, the length of time since the offense and the seriousness and nature of the violation will be taken into account.
o Yes o No
If yes, give details:

Authorization and Signature

PLEASE READ CAREFULLY BEFORE SIGNING. WE WILL CONSIDER YOU FOR EMPLOYMENT ONLY AFTER YOU SIGN THIS APPLICATION

I hereby certify that the information I have provided in this application is true and complete to the best of my knowledge and belief. I understand that any false or misleading information or misrepresentations by omission in my application form or any related document, interviews, or other aspect of my application can result in my disqualification as a candidate for employment, or my immediate discharge if already employed.

I authorize and request any and all of my former employers, and any other person to furnish to Child First Authority, Inc. or any agent acting on its behalf, any information they may give concerning my character, general reputation, personal characteristics, business activities, educational background and creditworthiness, together with, in the case of former employers, a history of my employment by them and the reasons for the termination thereof. Moreover, I hereby release such employer and each such person from any and all liability of whatsoever nature by reason of furnishing said information to the Child First Authority, Inc. or any agent acting on its behalf. I further permit Child First Authority, Inc., or any agent acting on its behalf, to show any former employer a copy of this application and this acknowledgment of consent.

I understand that nothing in this application, the granting of an interview or subsequent employment by Child First Authority, Inc. of me, constitutes an express or implied contract for initial or continued employment. If an employment relationship is established, I understand that my employment will be “at will” and of an indefinite duration, that I have a right to terminate my employment at any time with or without cause and that Child First Authority, Inc. retains a similar right to terminate my employment with or without cause. I understand that no person has any authority to enter into any agreement contrary to the foregoing and that the only statement of the terms and conditions of any employment I may be offered shall appear in a written offer letter.

NOTICE TO MARYLAND APPLICANTS

“UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.”

Applicant’s Signature Date

Application for Employment Page 1 of 4 10/12/2017