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.