Application for Employment

Ebenezer Child Care Centers, Inc. is proud to be recognized as a leader in the child care industry. Thank you for applying with us.

In addition, Ebenezer is proud to be an Equal Opportunity Employer. This form is intended to collect information relevant to the selection decision. We do not discriminate on the basis of race, national or ethnic origin, religion, gender, age, disability, veteran status, sexual orientation, or any other status protected by law.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Note: Convictions are not an automatic bar to employment.

Please list all details include address of school


Employer
Address
Phone Number
Job Title
Supervisor
Reason for leaving
Dates Employed (From - To)
Hourly Wage/Salary:(Starting & Ending)


Employer
Address
Phone Number
Job Title
Supervisor
Reason for leaving
Dates Employed (From - To)
Hourly Wage/Salary:(Starting & Ending)


Employer
Address
Phone Number
Job Title
Supervisor
Reason for leaving
Dates Employed (From - To)
Hourly Wage/Salary:(Starting & Ending)


Employer
Address
Phone Number
Job Title
Supervisor
Reason for leaving
Dates Employed (From - To)
Hourly Wage/Salary:(Starting & Ending)

Full TimePart TimeSummer Only

Downtown Center: 340 W. St. Paul Avenue, Milwaukee, WI 53203Oak Creek Center: 220 W. Forest Hill Avenue, Oak Creek, WI 53154West Allis/Wauwatosa: 1136 S. 108th Street, West Allis, WI 53214

	Name	Position/ Company	Relationship	Address	Phone
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I hereby authorize Ebenezer Child Care Centers, Inc. to investigate my background, and verify all information which I provided in this application or otherwise. I release Ebenezer and its subsidiaries from any liability arising out of their investigation of my application for employment. I further authorize my past employers to share with Ebenezer any information concerning my employment that may be relevant to making an employment decision, and release all parties from any liability for damage that may result from furnishing this information. I certify that this information and any supporting documents that I have provided or will provide to Ebenezer, whether oral or written, is correct to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of fact will constitute grounds for the rejection of my application, withdrawal of an offer of employment, or immediate dismissal from employment with Ebenezer regardless of when the falsification is discovered.

I have read and understand each of the statements above, and sign this form in return for consideration for employment in the job specified.

E M P L OY M E N T

General Information

Emergency Contact Information

Background

Education

Employee Experience

Preferences

Additional Information

FOR PERSONNEL DEPARTMENT USE ONLY