Today's Date:
Personal:


Name:
Address:
Mailing address (if different from above):
Home Phone Number :
Mobile Number :
E-mail address:
Referred by:
Is a relative employed here?:
YesNo
If yes, Name:
In case of an emergency who may we contact?
Interest:
Position applying for:
Available hours:
Full timePart time
Hours available:
Desired Rate Of Pay:
Have you previously been employed by us?
Briarwood Child Academy has programs located in the following areas.Please circle the location(s) you are willing to work.

Hanover, MANorth Smithfield, RISeekonk, MASmithfield, RI
Why do you want to work in the child care profession?
Date you can begin employment:
Education:
 
Name & Location
Of School
Years Attended
Date Graduated
Major Course of Study
High School
College
Other
**Must present copy of diploma or transcript for all educational degrees for high school and beyond**
General subjects of special study or reference work
What other language do you fluently speak/read other than English?
Employment:
Employer
Name & Address
Dates
of Employment
Telephone Number
Very Important
Position
Salary
Reason for Leaving
May we contact you current employer?
YesNo
Federal Background Check:
Have you ever been convicted of a felony?
In what year?
All employees must pass a background check which includes fingerprinting, CANTS, and reference checks. Is there anything on your criminal record which may appear on your background check?
YesNo
If yes, please explain
Professional References:
Below please list the names of three people who know you on a professional level.
Reference Name
Address
Address, City, State, Zip
Telephone Number
Very Important
Years Known
Relationship
Legal:
Are you a U.S. citizen?
YesNo
If no, do you have a legal right and the necessary documents to work in the U.S.?
YesNo
I authorize the investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of wages and salary, be terminated at any time without any previous notice.

Briarwood Child Academy does not discriminate on the basis of race, color, sex, religion, national origin, ancestry, age, disability, or marital status. Briarwood Child Academy is an equal opportunity employer and your response to any questions will not be used as a basis for discrimination, but will be judged on its relevance to the position you are seeking. (The Age Discrimination in Employment Act of 1987 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.)

EMPLOYMENT OR CONTINUATION OF EMPLOYMENTIS CONTINGENT UPON THE CLEARANCE OF CANTS, FINGERPRINTS AND OTHER BACKGROUND CHECK INFORMATION. IF, AT ANY POINT OF EMPLOYMENT, AN EMPLOYEE CAN NOT BE CLEARED BY CANTS OR THE BACKGROUND CHECK THE EMPLOYEE MAY BE SUSPENDED OR TERMINATED IMMEDIATELY WITHOUT PAY UNTIL PROOF OF CLEARANCE IS RECEIVED.