APPLICATION FOR EMPLOYMENT
Specialized programs for your busy bees, ages 2-7.
8922 Cuming, Omaha, NE   68114
(402) 926-4373
Printable Version: Download the Application in Word


To be considered for any position, all sections of the application must be completed. Your application will remain active for 12 months.

Last Name
First                     MI
Home Phone Business Phone
Message Phone Position(s) applied for
Full-time Part-time Site Location(s) Preferred
Salary Expected Date of Application
Date Available

Have you ever been employed with Behave'n Day Center, Inc.?

Yes No

If yes, position

Dates of Employment

Where did you learn about the position?

email address:
Home address:                                    

   
PERSONAL DATA

Are you eligible to work in the United States?

Yes No

Have you ever been convicted of a criminal offense(felony or misdemeanor)?

Yes No

Have you ever been convicted of a sexual offense?

Yes* No

 

*If “yes”, please identify nature and date(s) of offense(s)

Do you have a valid driver’s license?

Yes No

 State Licensed
Number Expiration Date

During the past three (3) years, have you been denied a driver's license or convicted of a moving traffic offense, including but not limited to speeding, at fault accidents, driving while intoxicated or reckless driving?

Yes No

If yes, please specify the nature and number of offenses(s) as well as dates

*Note Answering "Yes" to a violation or conviction above does not automatically disqualify you from employment since the nature of the offense(s), the date of the offense(s) and type of job(s) for which you are applying will be considered.

 

SKILLS

Please list your most current skills (include foreign or sign languages) which qualify you for the position you seek.

Please include your years of experience.

Professional:
Clerical:

Child Care:

Computer:

Foreign Language:

  

 

EDUCATION

Please list ALL education, including high school, starting with the highest year completed.

Name of High School, College, University, TechnicalCollege, etc.

City, State

Course of Study

Dates Attended

Graduate

Yes No
Yes No
Yes No

More info:

LICENSES OR CERTIFICATIONS

Please list license or certifications applicable to the position for which you have applied

EMPLOYMENT HISTORY

Please list all employers. Begin with most recent or present. Supervisor phone is required.

1. Employer

Supervisor

Phone

Address

City, State, Zip

Position Title

Full-time Part-time

Dates of Employment From: To

Starting Salary

Final Salary

Reason for Leaving

Brief Explanation of Job Duties

May we contact your Employer?
Yes No

2. Employer

Supervisor

Phone

Address

City, State, Zip

Position Title

Full-time Part-time

Dates of Employment From: To

Starting Salary

Final Salary

Reason for Leaving

Brief Explanation of Job Duties

May we contact your Employer?
Yes No

3. Employer

Supervisor

Phone

Address

City, State, Zip

Position Title

Full-time Part-time

Dates of Employment From: To

Starting Salary

Final Salary

Reason for Leaving

Brief Explanation of Job Duties

May we contact your Employer?
Yes No

4. Employer

Supervisor

Phone

Address

City, State, Zip

Position Title

Full-time Part-time

Dates of Employment From: To

Salary Starting

Final

Reason for Leaving

Brief Explanation of Job Duties

May we contact your Employer?
Yes No

   
PERSONAL REFERENCES

References:

Telephone #'s (important. Please list a working phone number.)

Years Known

Relationship

(i.e. friend, neighbor, etc.)

(No relative or past or current supervisors)

Name

Address

Home

Work

Name

Address

Home

Work

Name

Address

Home

Work

APPLICABLE VOLUNTEER SERVICE

Organization Date Volunteered to

Supervisor Business No. Home No.

Organization Date Volunteered to

Supervisor Business No. Home No.

I hereby authorize the release, to the Behave’n Day Center, Inc. (BDC, Inc.), any educational institutions I have attended, previous and current employers, law enforcement agencies, and any others who possess information about me to release any and all such information to BDC, Inc.  In a manner consistent with this authorization.  I also hereby release BDC, Inc. from any and all claims or causes of action, in law or equity, which I might otherwise have, arising from the transmittal of such information to BDC, Inc. and its use of it.

-      I certify that the statements made in this application are true and correct to the best of my knowledge, and that falsification of any information contained herein may result in summary termination of my employment.
-      An investigation may be done to obtain character information from employers, neighbors, friends, colleagues and associates, and others who may have knowledge of me.
-      A satisfactory evaluation of my knowledge, skills, abilities and overall suitability for employment, determined in part on the basis of any results and conducted by BDC, Inc. in its sole and unlimited discretion, shall be a condition to employment. I shall take all tests required for the position I seek.
-      I shall provide proof of citizenship or authority to work in the United States.
-      I hereby understand and acknowledge that any employment relationship with BDC, Inc. is of an “at will” nature, which means that I may resign at any time and that BDC, Inc. may terminate my employment with or without cause at any time.
-      BDC, Inc. may change the terms and conditions of my employment at any time without giving notice.
-      No one but the CEO or a designated representative has the authority to enter into any contract for employment with me which contains terms that are contrary to any herein.
-      If my employment ends, BDC, Inc. may provide confidentially to any prospective employer my records with no liability to itself or its staff.
-      I am capable of performing the essential functions of my job with or without accommodation.
-      I do not use illegal substances.
-      I have reported to Behave’n any current or past adverse actions that may present risk management concerns (malpractice, criminal convictions, Medicare/Medicaid sanctions, ethical violations.)
-      I have reported to Behave’n any history of Loss of Professional License or Limitation of Privileges or disciplinary actions.
-      Behave’n Day Center, Inc. is an Equal Opportunity employer and adheres to all anti-discrimination laws, local, state, and federal.

I have read and agree to the above terms of employment. By submitting this application I am confirming that all information is accurate and current.

Name

Date