CME Employment Application "*" indicates required fields CommentsThis field is for validation purposes and should be left unchanged.Please print clearlyToday's Date* MM slash DD slash YYYY Preferred First NameLegal First Middle Last Any additonal information about your name we would need to verify your employment/ education record:Present Street AddressCity, State, ZipPermanent AddressPhone [cell]Email Address Social Security NumberAre you eligible to work in the United States? Yes No Do you require visa assistance in order to do so? Yes No Have you ever served in the U.S. Armed Forces ? Yes No If Yes indicate Rank:Rating at discharge:Have you ever been convicted of a misdemeanor or felony (not including minor traffic violations)? Yes No If yes, list date, offense and disposition:Position for which you are applying:If a child care position: Working with small children requires the ability to run, bend and sometimes lift up to 50 lbs. Is there any physical condition that would prevent you from performing these and similar physical components of the position for which you are applying? Yes No If yes please specify any accommodation that might permit you to perform these physical requirements:WORK BACKGROUND (include internship site if recent):1. Previous EmployerPositionSupervisorPeriod of EmploymentFrom: MM slash DD slash YYYY To: MM slash DD slash YYYY Reason for Leaving2. Previous EmployerPositionSupervisorPeriod of EmploymentFrom MM slash DD slash YYYY To MM slash DD slash YYYY Reason for LeavingEDUCATIONAL BACKGROUND (include high school through graduate school):SchoolName/AddressMajorDegree ReceivedMONTESSORI CERTIFICATIONTeacher Education ProgramLevelDurationDate CertifiedTeacher Education ProgramLevelDurationDate CertifiedAre your currently enrolled in any educational programs? (please describe)Do you belong to any professional organizations? (please list)REFERENCES (please list 3 people who we may call/email and who are unrelated to you). We will need a written, formal reference sent to us by each of these as well prior to your hire.1. NameTitleCompanyAddressWork PhoneCell PhoneEmail Address 2. NameTitleCompanyAddressWork PhoneCell PhoneEmail Addess Please attach a copy of your resume APPLICANT'S CERTIFICATION & AGREEMENT (Please read carefuly before signing) I HEREBY certify that the information set forth in this employment application or furnished by me otherwise is true, correct and complete to the best of my knowledge. I understand that if employed, any statement made by me that is contrary to this representation, or found to be false or misleading, shall be considered sufficient cause for immediate discharge at any time. In the event that I am employed by CME|NY, I agree to abide by and comply with all instructions given to me by center authorities, and with all the center rules, policies and regulations. I hereby authorize my former employers to give any information regarding my employment with them, and I also authorize investigation of all statements contained in this employment application as may be necessary in arriving at an employment decision.Applicant's SignatureDate MM slash DD slash YYYY CAPTCHA
