Employment Application

Personal Information

First Name *

Middle

Last Name *

Address *

Address

Street Name

Apt/Unit/Suite/Etc

City

State/Province

Zip/Postal

Phone *

Email *

Employment

Are you currently employed by LEO? *

Yes

No

Have you ever been employed by LEO? *

Yes

No

If yes to either question above, please complete the following information:

Position *

Date - From *

Date - To *

Reason for Leaving *

Immediate Family Working at LEO

Please disclose the names of any immediate family members including spouse, parent, child, or sibling who are current LEO employees.

LEO will not allow an immediate family member to directly supervise another family member. Additionally, LEO will not allow two immediate family members to work for the same Program Director without express written consent of the CEO.

Family Member Name

Relationship

Position

Availability & Eligibility

Please list days and hours you are available to work:

Are you at least 18 years of age? *

Yes

No

Are you legally eligible to work in the United States, an can you submit verification of your legal right to work in the United States upon being offered a position? *

Yes

No

Have you been found to have abused or neglected a child either in Massachusetts or elsewhere? *

Yes

No

Employment History

Please begin with your most recent employment and continue with all past employment.

Employment History section must be completed in full even in your resume is submitted.
Applicants may include verifiable work performed on a volunteer basis.

List Employment

Most Recent Employer

Position Held

Start Date

End Date

Employer Address

Street Name

Apt/Unit/Suite/Etc.

City

State/Province

Zip/Postal

Job Duties

Reason for Leaving

Employer Phone

Supervisor's Name

May we contact this employer?

Yes

No

Add Remove

Education & Skills

All Applicants:

If you are selected for a position with minimum educational requirements or specific certifications, a copy of your transcripts, diploma, GED or certifications will be required prior to employment.

Did you graduate from high school? *

Yes

No

If not, have you obtained a GED?

Yes

No

Please list any other training or skills, including computer language skills, that are relevant to this position:

Please list any colleges or technical schools you have attended:

Name of School

City, State

Subject Studied

Degree/Certificate

Add Remove

Early Childhood Education Applicants

Have you earned a Preschool Child Development Associate (CDA)?

Yes

No

Have you earned an Infant Toddler CDA?

Yes

No

Do you have a Department of Early Education and Care (DEEC) license?

Yes

No

If yes, check all that apply *

Please list recent Continuing Education Units (CEUs), trainings or other education

Driver's License Information

Do you have a valid driver's license? *

Yes

No

Do you have a bus driver's license?

Yes

No

If yes, please provide the following information:

State

Class

Endorsements

Professional References

List at least two people not related to you who can comment on your work performance.

List Professional References

First Name

Last Name

Address

Street Name

Apt/Suite/Unit/Etc.

City

State/Province

Zip/Postal

Occupation

Telephone Number

Years Acquainted

Add Remove

Referral Source

How did you hear about this position?

Statement of Interest

Please tell us about your interest in this position and what you think would be able to contribute to LEO

Notification & Agreement

All of the information that I have provided on this application is accurate to the best of my knowledge. I authorize Lynn Economic Opportunity, Inc. to make inquiries to determine my suitability for employment. In signing this application, I understand that my previous and present employers may be asked for information relative to my employment record with them. Further, I understand a Background Records Check may be completed prior to employment. An additional release for the Background Records Check will be provided as part of the application process.

I understand applicants for all positions within the Early Childhood Development Program who have direct contact with children are required to undergo a post-offer, pre-employment medical examination to be conducted by a physician designated or approved by LEO. Any conditional offer of employment that an Early Childhood Development Program applicant receives from LEO is contingent upon, among other things, satisfactory completion of this examination and screening and a determination by LEO and its examining physicians that the applicant is capable of performing the essential functions of the position that has been offered, with or without reasonable accommodation.

It is the policy of LEO to afford equal opportunity to all employees and applicants without regard to age, race, religion, color, sex, national origin, marital status, expunged juvenile records, pregnancy, sexual orientation, ancestry, or genetic information; and afford equal opportunities to disabled veterans of the Vietnam era and to individuals with a disability or any other characteristic protected by Federal, State or Local Law.

I fully understand and agree that any section left incomplete on this application; any false, inaccurate and/or misleading statements made by me on this application or by me failure to answer any applicable questions on the application; any false, misleading, or inaccurate information contained on the certificates, documents, or other papers which may accompany this application (i.e. misrepresentation of prior employment, education, or training); or any false, misleading or inaccurate information provided during the entire selection process will be sufficient cause for my application being rejected or for my discharge from LEO at any time after employment.

Please recheck your application and make sure that all questions are answered correctly prior to signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

Signature of Applicant *

Date

Printed Name of Applicant *

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

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