Required Fields (*)
Personal Information
* Name:
* Address:   * Home Phone:
* City: Work Phone:
* State: * E-Mail:
* Zip Code:   May we contact you at work?
* Position applying for: *Check all that apply:
How were you referred to SHCS?
If by current staff member, please list name.

* Date Available:   *Are you an Early/Head Start parent?
Name Address Degree/Area of Study Graduated
* High School:
Graduate School:
US Military Service
Branch of Military Technical Specialization Rank Attained
*Are you a U.S. citizen or do you have a legal right & necessary documents to work in the U.S.?  
*Were you ever discharge by any company?  
If yes, give name of company(ies) and reason for discharge:
*Have you ever been convicted of a crime other than minor traffic violation? (NOTE: you are not obligated to discuss sealed or expunged records of conviction or arrest nor will such information be asked of you or considered in employment decisions.) The existence of a criminal record will not automatically disqualify you from the job for which you are applying.
If yes, please explain offense and final disposition:
Employment History

List employment starting with your most recent position. Account for any time during this period that you were unemployed by stating the nature of your activities.

May we contact your present employer?   May we contact your past employer?
Have you previously worked for Seton Hill Child Services?   If so, please state when:
* Employer Name: *Start Date:
* Address: *End Date:
* Supervisor:
* Position Held:
* Reason for leaving: *Salary/Wages:
Employer Name: Start Date:
Address: End Date:
Position Held:
Reason for leaving: Salary/Wages:
Employer Name: Start Date:
Address: End Date:
Position Held:
Reason for leaving: Salary/Wages:
References  (* three required)
* Name/Title Address Work Phone Years Known
Please Read Carefully
I understand that, with my application, an investigation may be made whereby information is obtained regarding my character, previous employment, general reputation, educational background, credit record and/or criminal history, subject to applicable federal, state and/or local laws.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate dismissal. I understand also, that I am required to abide by all rules, policies and regulations of Seton Hill Child Services, Inc.

I understand and agree that if employed, the employment will be “at will”. That is, either I or Seton Hill Child Services, Inc. may end the employment relationship at any time for any reason, or for no reason. I understand that receipt of this application by Seton Hill Child Services, Inc. does not imply employment and that this application and/or any other Seton Hill Child Services, Inc. documents are not contracts of employment.

*Applicant's Signature:
(Please type full name)
Date: 2/20/2018