Name
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
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5
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8
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11
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31
Day
Please select a year
2026
2025
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2023
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1923
1922
1921
1920
Year
Phone Number
*
Format: (000) 000-0000.
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How were you referred to us?
*
Walk-In
Referral
Newspaper Ad
Facebook
Twitter
LinkedIn
Other (please specify)
Position Applied For:
ELC Director
ELC Assistant Director
ELC Teacher
ELC Teacher's Assistant
EAC Skills Captain (Enrichment Course Instructor)
EAC Quest Leader (Entry-Level Assistant)
Desired Pay:
Employment Type:
Full-Time
Part-Time
Either
High School:
Name of the school you attended
Diploma/GED Received?
Yes
No
College/University:
Name of the College or University attended or N/A
Degree(s):
If none, type N/A
Major:
If none, type N/A
Minor:
If none, type N/A
Training and Certifications
Employment History
Please list your last three employers, starting with the most recent.
Employer 1: Company Name
*
Dates of Employment:
*
Example: Dec 2020 to Jan 2025
Job Title:
*
Supervisor's Name:
*
Employer 1 Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer 1: Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Duties Performed:
*
Reason for Leaving:
*
Employer 2: Company Name
*
Dates of Employment:
*
Example: Dec 2020 to Jan 2025
Job Title:
*
Supervisor's Name:
*
Employer 2: Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer 2: Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Duties Performed:
*
Reason for Leaving:
*
Employer 3: Company Name
*
Dates of Employment:
*
Example: Dec 2020 to Jan 2025
Job Title:
*
Supervisor's Name:
*
Employer 3: Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer 3: Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Duties Performed:
*
Reason for Leaving:
*
Certifications and Health Requirements
CPR/First Aid Certification: Do you have valid infant/child CPR and First Aid certification? (Required for all staff)
*
Yes
No
Tuberculosis (TB) Documentation: Do you have documentation from a health professional confirming you are free of active tuberculosis? (Required upon hiring and every two years)
*
Yes
No
Health Statement: Do you have physician's statement documenting satisfactory general health to care for children?
*
Yes
No
Employment Status: Will you be employed elsewhere during the operating house of this facility?
*
Yes
No
Background Checks and Disclosures
All applicants must undergo a mandatory national and state background check which includes the National Sex Offender Registry, State Sex Offender Registry, and the Child Abuse and Neglect (CAN) central registry. Disqualifying offenses will prevent employment.
Have you ever been convicted of a crime?
*
Yes
No
If YES, please explain:
*
Have you ever been the subject of any findings of child abuse or neglect by a government regulatory agency?
*
Yes
No
Have you ever been disciplined or terminated from a previous childcare position?
Yes
No
References
Please list two (2) references that are familiar with your work life.
Reference 1
*
Reference 2
*
Background Check Consent
I hereby authorize EMI (Echo Ministries Inc.) to conduct a full background check, including criminal history and fingerprinting, as a condition of employment. I understand that the information obtained will be used for employment purposes only and will be handled in accordance with applicable laws.
Signature and Certification
I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any false or misleading statements may be considered cause for dismissal or refusal of employment. I authorize my previous employers, references, and educational institutions to release any information they have concerning my employment or qualifications to EMI (Echo Ministries Inc.).
Signature
*
Date
*
-
Month
-
Day
Year
Date
Upload Resume
*
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