Employment Application

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ABC Children’s Academy and

Developmental Center, Inc.

Owners: Kirk and Dana Warren

Admin Email: dana.warren@myabcca.com

Pope County Director Phone: 479-968-5048

Yell County Director Phone: 479-229-2000

Johnson County Director Phone: 479-647-5080

Admin Fax: 479-280-1176

Employment Application Rev. 02-20

Please answer each question fully and accurately. No action can be taken on this application until all questions have been answered. Please print except for your signature on the last page.

Full Nameyour full name

Date of Applicationof appointment

Complete AddressComplete Address

Social Security Number

1st Contact Number

2nd Contact Numberyour full name

Email Addressa valid email

Are you at least 18 years of age?

YesNo

Position Applying ForPosition Applying For

Pay DesiredPay Desired

Which do you prefer to work?

Full TimePart Time

Date Available to Startof appointment

Referred byyour full name

Please fill in the hours each day that you are available to work.

Monday	Tuesday	Wednesday	Thursday	Friday
					×

(1)

Have you ever worked for ABC Children’s Academy before?

YesNo

If YES, please list dates of employment and location(s) workedIf YES, please list dates of employment and location(s) worked

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Do you have a checking account for Direct Deposit of your Paycheck?

YesNo

Has a court ever denied you parent custodial or visitation rights as a result of child neglect or maltreatment?

YesNo

If YES, explainmore details

0 /

Have you ever been convicted or have charges pending of a criminal offense of any kind?

YesNo

If YES, explainmore details

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Do you have any limitations that would restrict job performance or that would put children at risk?

YesNo

If YES, explainmore details

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Are you or your spouse a registered sex offender?

YesNo

Do you acknowledge that the use of marijuana either medically or recreationally while working in a childcare is not allowed according to Article 98 of the Arkansas Constitution?

YesNo

Would you take a physical examination if required?

YesNo

Are you now or have you ever used illegal drugs?

YesNo

Would you be willing to take a drug screening?

YesNo

Are you now or do you expect to be engaged in other business or employment?

YesNo

If YES, explainmore details

0 /

Educational History

Type of School	Name of School	City & State	Major	Years Completed	Date & Degree Earned
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(1)

ReferencesName, complete addresses, and phone numbers of the people we may contact about you. No relatives or former employers, please.

Name	Phone	Complete Address
			×

(1)

Employment HistoryList your last 6 years of employment: employers, assignments, or volunteer activities, starting with your CURRENT or most recent employer, including military experience.

Ref. Ck (Office Use Only)	Employers Name	From	To	Duties	Supervisors name	Supervisors Phone	Reason for Leaving
								×

(1)

In Case of EmergencyName, Complete Address, home & work phone numbers of the person we may call in case of an emergency:

Name	Complete Address	Home #	Work #
				×

(1)

AFFIDAVIT: I CERTIFY THAT EVERYTHING IN THIS APPLICATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT MISLEADING OR INCORRECT STATEMENTS OR CONSEQUENTIAL OMMISSIONS MAY RENDER THIS APPLICATION VOID, OR IF EMPLOYED, WOULD BE CAUSE FOR TERMINATION. I AUTHORIZE THE INDIVIDUALS OR INSTITUTION RELEASING THEM FROM ALL LIABILITY FOR ISSUING SUCH INFORMATION.

Upload Resume (Optional)

Dateof appointment

SignatureI agree to the terms and conditions

(Sign Here)

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