• Employment Application Form

    Please answer all questions below.
  • Birthdate*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.

  • Availability

  • When are you available to start?*
     - -
    2 digit month, 2 digit day, 4 digit year
  • What days and times are you available? Check all that apply. (Time Zone EST)*
    Rows
  • Do you have any restrictions on your availability?*

  • Screening & Safety

  • Are you legally authorized to work in the United States?*
  • Do you have any pre-existing injuries or ailments that would prevent you from performing your duties in this role?*
  • Do you have any health, allergy or dietary restrictions?*
    • Educator Clearances & Experience - Start 
    • Have you ever been the subject of a child abuse or neglect investigation by any federal, state, or local authority?*
    • Have you ever been convicted of, pled guilty, or pled no contest to a criminal offense, including any crimes involving child abuse, child neglect, sexual abuse, or other crimes of moral turpitude?*
    • Have you ever had an educator license or certificate suspended, revoked, or denied, or have you voluntarily relinquished a license or certificate in any jurisdiction?*
    • Have you ever been disciplined, discharged, or asked to resign from a position for conduct related to child abuse, sexual misconduct, or harassment?*
    • Have you ever resigned or been terminated from any employment while under investigation for allegations of child abuse or sexual misconduct?*
    • Can you provide a written release for the Maryland State Department of Education to contact all previous employers for verification of this information?*
    • Educator Clearances & Experience - End 
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    • Authorization to Contact Previous Employers and Release of Information

      In compliance with Section 6-113.2 of the Education Article, Maryland Annotated Code, I, the undersigned, hereby authorize Language Immersion Learning and/or its designated representatives to contact any or all of my previous employers for the purpose of verifying employment history and obtaining information concerning my professional conduct, including, but not limited to, any investigations into allegations of child abuse, sexual misconduct, or any other criminal activities that may have occurred during my employment.

      I further authorize all previous employers and any law enforcement or child protection agencies to release any and all information, including documents, investigative files, and records pertaining to my employment and conduct as it relates to my fitness to work with children, as required by Maryland law.

      I release Language Immersion Learning, my previous employers, and all other entities involved from any liability or claims arising out of the release or sharing of such information. I understand that this authorization is required as part of the application process and that failure to provide this release will result in my application not being considered for employment.

    • Authorization and Signature

      By typing your name below, you certify that all the information provided in this questionnaire is true, accurate, and complete to the best of your knowledge. I understand that falsification or omission of any information can result in denial of employment or immediate termination of employment if hired. Typing your name in the designated field acts as your electronic signature.

    • Today's Date
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