Employment

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 * Do you currently have a clean and valid New York State Drivers License?

 * If you are under 18 years of age, can you provide required proof of your eligibility to work?

 * Have you ever filed an application with us before?

 * Have you ever been employed with us before?

 * Are you currently employed?

 * May we contact your present employer?

 * Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship/immigration status will be required upon employment.

 * Are you available to work (check all that apply):

 * Is there any reason known to you why you may not be able to perform consistently and properly any of the outlined functions with or without reasonable accommodation?

 * Have you ever been convicted of a crime, including misdemeanors and summary offenses, which has not been annulled or expunged or sealed by a court?

If yes, please explain in full

(A record of conviction will not automatically disqualify an applicant, however, the type and seriousness of a crime, frequency of violations, date of conviction, applicant's age at time of conviction, and the applicant's entire work and educational history will be evaluated.)

The agency conducts background examinations of new employees to determine if any record of criminal activity exists. This is done by fingerprinting all new employees who will be engaged directly in the care and supervision of children. These fingerprints are then submitted to the New York State Division of Criminal Justice Services, where they are used to determine whether a history of criminal activity exists.

 * Have you ever served in the United States military?

If yes, please describe your military service

Name & Location

High School Years Completed (check all that apply):

High School Diploma/Degree Obtained

Name & Location

Undergraduate Years completed (check all that apply):

Undergraduate Diploma/Degree Obtained

Name & Location

Graduate/Professional Years completed (check all that apply):

Graduate Diploma/Degree Obtained

Please provide Names and Contact Numbers for 3 professional references.

 * Reference 1:

 * Reference 2:

 * Reference 3:

Allowed file types:   (.pdf)

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I hereby acknowledge that any employment relationship with this Agency is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledge in writing by an authorized executive of the Agency.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

I hereby acknowledge that I have read the above, and attest that the content is true and accurate.

 * In order to prevent abuse of the system, please enter the 6 digit numeric code you see below into the text entry field before submitting this form.