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Employment Application

Home » Employment Application

Employment Applicationtroia2023-09-21T20:20:29+00:00

Applicants are considered for all positions without regard to race, color, religion, or creed, sex, or sexual orientation, national origin, or citizenship status, age,
marital, or veteran status, or the presence of a non-related medical condition or disability. Please fill out the application in it’s entirety.

Personal Information

Name(Required)

First MI Last

Email(Required)

Home Phone

Mobile Phone(Required)

Address

Street Address City State & Zip Code

Are you entitled to work in the United States?(Required)

Yes

No

Are you 18 or older?(Required)

Yes

No

Do you have your OWN transportation?(Required)

Yes

No

Have you been sanctiond or otherwise disciplined by, or excluded from, the New York Medicaid Program, Medicare or any other state or federal government funded program?(Required)

Yes

No

If yes, please explain

Expected Hourly Rate(Required)

Expected Weekly Earnings(Required)

Days Available(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

Date Available(Required)

Hours Available(Required)

Have you ever been or are you currently the subject of an indicated child abuse or maltreatment report on file with the Uew York Statewide Central Register of Child Abuse and Maltreatment?(Required)

Yes

No

If yes, please explain

Have you ever been investigated by, or subject to a disciplinary proceeding by a professional licensure or disciplinary agency (such as the Office of Professional Discipline, the Office of Professional Medical Conduct, or the Department of Health), in New York or in any other state?(Required)

Yes

No

If yes, please explain

Military Service(Required)

Yes

No

If yes, what branch?

Currently

Yes

No

Veteran

Yes

No

What position are you applying for?(Required)

How did you hear about this position?(Required)

Upload your resume and cover letter(Required)

Drop files here or

Accepted file types: pdf, docx, doc, Max. file size: 50 MB.

Prior Work Experience

Current or Most Recent Employer Name

Current or Most Recent Employer Address

Street Address City State and Zip Code

Current or Most Recent Employer Phone

Name of Immediate Supervisor

May We Contact

Yes

No

Dates of Employment

MM slash DD slash YYYY

To

Dates of Employment

MM slash DD slash YYYY

From

Position/ Job Title

Reason for Leaving

Prior Employer Name

Prior Employer Address

Street Address City State and Zip Code

Prior Employer Phone

Name of Immediate Supervisor

May We Contact

Yes

No

Dates of Employment

MM slash DD slash YYYY

From

Dates of Employment

MM slash DD slash YYYY

To

Position/ Job Title

Reason for Leaving

Education

If not stated on resume

High School Name/ Location

High School Lat Year Completed

College/ University Name & Location

College/ University Last Year Complete

College/ University Degree

College/ University Major or Emplasis

Grad School Name & Location

Grad School Last Year Complete

Grad School Degree

Grad School Major or Emphasis

Trade School Name & Location

Trade School Last Year Complete

Trade School Certification

Trade School Major or Emphasis

List any applicable special skills, training or proficiencies

Professional References

Reference #1 Name

Reference #1 Relationship

Reference #1 Phone

Reference #1 Email

Reference #2 Name

Reference #2 Relationship

Reference #2 Phone

Reference #2 Email

Reference #3 Name

Reference #3 Relationship

Reference #3 Phone

Reference #3 Email

Disclaimer

By signing, I hereby certify that the above information, to the best of my knowledge, is correct. I understand that falsification of this information may prevent me from being hired or lead to my dismissal if hired. I also provide consent for former employers to be contacted regarding work regards.

Signature

Date

MM slash DD slash YYYY

Located at the Maplewood School in Watervliet, NY, Kids Express is the leading early childhood learning center in the Capital Region. Our programs include Preschool and Universal Pre-K (UPK).

Administrative Office

623 New Loudon Road
Latham, NY 12110

email

KidsExpressInfo@gmail.com

Phone

(518) 782-5404
Fax: (518) 782-3433

Maplewood School

32 Cohoes Road
Watervliet, NY 12189

email

KidsExpressInfo@gmail.com

Phone

(518) 328-0430
Fax: (518) 328-0428

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