(The offense(s) and how recently you were convicted will be evaluated in relation to the job which you are applying.)
EDUCATION
High School
College or University
Graduate or Professional
Vocational/Technical School
REFERENCES
WORK HISTORY
(List child care/early childhood experience first)
I certify that I have given true, accurate, and complete information on this form to the best of my knowledge. In the event confirmation is needed in connection with my work, I authorize educational institutions, associations, registration, and licensing boards, and others to furnish whatever detail is available concerning my qualifications. I authorize investigations of all statements made in this application and understand that false information of documentation, or a failure to disclose relevant information may be grounds for rejection of my application, disciplinary action, or dismissal if I am employed, and (or) criminal action. I further understand that dismissal on unemployment shall be mandatory if fraudulent disclosures are given to meet position qualifications.
