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Employment Application (GA & AL)

  • Personal Information:

  • EDUCATION:

  • Type of Diploma or Degree received upon completion
  • Type of Diploma or Degree received upon completion
  • Child Care Training

  • Work Experience

    Most recent position first
  • Briefly describe your duties, responsibilities and accomplishments while employed
  • Briefly describe your duties, responsibilities and accomplishments while employed
  • Briefly describe your duties, responsibilities and accomplishments while employed
  • Briefly describe your duties, responsibilities and accomplishments while employed
  • Criminal History Record

    The criminal history background information check shall be completed on each substitute, caregiver, volunteer, and domestic worker, as well as any other person who has contact with the children or unsupervised access to the children shall be reviewed. You must complete a Mandatory Criminal History Notice Form and a Criminal History Information Consent and Release Form. The fee will be payroll deducted. If you previously had a criminal history check done for the Department of Human Resources and the required information is on file, it is not necessary to complete a fingerprint criminal history check.
  • Clearance of State Central Registry on Child Abuse/Neglect: A completed REQUEST FOR CLEARANCE OF STATE CENTRAL REGISTRY ON CHILD ABUSE/NEGLECT (DHR-DFC-1598) shall be obtained for each caregiver, substitute, volunteer, domestic worker, and any other person who has contact with the children or unsupervised access to the children.
  • References

    List at least three persons who are not related to you by blood, marriage, or adoption, to be contacted as references. At least one must be a former employer. Addresses must be complete and accurate.
  • Emergency Contact Information

    Please list at least two people to contact in case of emergency
  • By signing this form, I am affirming that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions in my application or in the interview may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I authorize persons, schools, my current employer (if applicable) and previous employers and organizations names in this applicant (and accompanying resume, if any) to provide any relevant information that may be required to arrive at an employment decision. In consideration of my employment, I agree to confirm to the policies and rules of this company and further agree and understand that my employment can be terminated, with or without cause, at any time at the discretion of the employer or myself.
  • Please use your initials as your signature