We do not discriminate in hiring or employment on the basis of race, color, religion, national origin, sex, age, disability or any other factor prohibited by law or regulation. No question on this application is intended to secure information to be used for such discrimination.

Personal Information

Name *

First Name

Last Name

Social Security Number *

Email *

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Are you at least 18 years of age?

Please list any immediate family members working for or have worked for the Center:

Position of Interest

What position are you applying for?

Starting wage/salary you are seeking?

When could you begin employment?

YYYY

Are there any limitations as to days/hours you are able to work?

If yes, please note the days/hours you would NOT be able to work.

Education

Did you gain a high school diploma or GED?

College Education

Verification will be required during the interview process

Associate Degree in Early Childhood/Related Field

Associate Degree in Unrelated Field

Bachelor Degree in Early Childhood/Related Field

Bachelor Degree in Unrelated Field

Master Degree in Early Childhood/Related Field

Master Degree in Unrelated Field

Training

Other Training/Certifications

Verification will be required during the interview process

Child Development Credential (CDA)

Current First Aid/CPR Certification

Pre-Service

Child Care Orientation Training (CCOT)

Pre-K ELLA

Infant/Toddler Frameworks

Preschool Frameworks

Other Training/Certifications

Estimated early childhood training hours completed:

Employment History

Have you ever worked for us before?

If yes, from

YYYY

May we contact your present employer?

Please list employment history for at least the past seven (7) years in chronological order with most recent positions first.

Present or Last Employer

Name and Title of Supervisor

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Employed from

YYYY

Employed to

YYYY

Starting Position

Starting Salary

Ending Position

Ending Salary

Briefly describe duties performed

Reason for leaving

Employer

Name and Title of Supervisor

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Employed from

YYYY

Employed to

YYYY

Starting Position

Starting Salary

Ending Position

Ending Salary

Briefly describe duties performed

Reason for leaving

Employer

Name and Title of Supervisor

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Employed from

YYYY

Employed to

YYYY

Starting position

Starting salary

Ending position

Ending salary

Briefly describe duties performed

Reason for leaving

General Information

Do you have documentation of an annual TB skin test?

Do you have documentation of a recent DTAP vaccine?

Are you authorized to work in the United States?

If not, please indicate the type of alien certification you have, as required for work by federal law

Would you like for your application to be forwarded to other parties if no positions are available?

Drug Screening

I hereby give consent to undergo drug screening as part of the pre-employment process and understand that the results thereof will be used to further determine by eligibility for employment. I further understand that if a detectable presence of illegal drug(s) is revealed a result of the screening procedures, I will be disqualified from further hiring consideration.

Background Report

Has a court ever denied you parental custodial or visitation rights as a result of child maltreatment?

Have you lived outside of the state of Arkansas for any period during the past six years?

Have you ever been convicted of any of the following:

1)Abuse of an Endangered or Impaired Person; 2) Arson; 3) Capital Murder; 4) Endangering the Welfare of an Incompetent Person; 5) Kidnapping; 6) Murder in the First or Second Degree; 7) Rape; 8) Sexual Assault in the First and Second Degree; 9) Criminal Attempt to commit any offenses in MLR Section 100.110; 10) Criminal Complicity to commit any offenses in MLR Section 100.110; 11) Criminal Conspiracy to commit any offenses in MLR Section 100.110; 12) Criminal Solicitation to commit any offenses in MLR Section 100.110; 13) Assault in the First, Second, or Third degree; 14) Assault, Aggravated; 15) Assault, Aggravated on a Family or Household Member; 16) Battery in the First, Second or Third Degree; 17) Breaking or Entering; 18) burglary; 19) Coercion; 20) Computer Crimes Against Minors; 21) Contributing to the Delinquency of a Juvenile; 22) Contributing to the Delinquency of a Minor; 23) Criminal Impersonation; 24) Criminal Use of a Prohibited Weapon; 25) Death Threats Concerning a School Employee or Students; 26) Domestic Battery in the First, Second, or Third Degree; 27) Employing or Consenting to the Use of a Child in a Sexual Performance; 28) Endangering the Welfare of a Minor in the First or Second Degree; 29) Endangering the Welfare of an Incompetent Person in the First or Second Degree; 30) Engaging Children in Sexually Explicit Conduct for Use in Visual or Print Media; 31) False Imprisonment in the First or Second Degree; 32) Felony Abuse of an Endangered or Impaired Person; 33) Felony Interference with a Law Enforcement Officer; 34) Felony Violation of the Uniform Controlled Substance Act; 35) Financial Identity Fraud; 36) Forgery; 37) Incest; 38) Interference with Court Ordered Custody; 39) Interference with Visitation; 40) Introduction of Controlled Substance into Body of Another Person; 41) Manslaughter; 42) Negligent Homicide; 43) Obscene Performance at a Live Public Show; 44) Offense of Cruelty to Animals; 45) Offense of Aggravated Cruelty to Dog, Cat or Horse; 46) Pandering or Possessing Visual or Print Medium Depicting Sexually Explicit Conduct Involving a Child; 47) Patronizing a Prostitute; 48) Permanent Detention or Restraint; 49) Permitting Abuse of a Minor; 50) Producing, Directing or Promoting a Sexual Performance by a Child; 51) Promoting Obscene Materials; 52) Promoting Obscene Performance; 53) Promoting Prostitution in the First, Second; 54) Prostitution; 55) Public Display of Obscenity; 56) Resisting Arrest; 57) Robbery; 58) Robbery (Aggravated Robbery); 59) Sexual Offense (Any); 60) Simultaneous Possession of Drugs and Firearms; 61) Soliciting Money or Property form Incompetents; 62) Stalking; 63) Terroristic Act or Threatening; 64) Theft by Receiving, Property or Services; 65) Transportation of Minors for Prohibited Sexual Conduct; 66) Unlawful Discharge of a Firearm from a Vehicle; 67) Voyeurism

I hereby acknowledge and authorize as part of the pre-employment process Helen R. Walton Children’s Enrichment Center to obtain a criminal background report of convictions, including FBI fingerprinting. You have a right within a reasonable period of time to request the source of our information.

Statement of Understanding

1. We make no promise of employment of offering this application form or accepting your written response. 2. No one is authorized to offer you employment with us except in writing. Do not make or change any plans based on what anyone tell you orally. 3. Any employment we may offer you will be terminable at will. This means you can quit anytime. It also means we can terminate you at any time; with or without cause. 4. By completing this application and signing below, you authorized us to investigate your qualifications and to make inquiries about you generally. You also authorize us to share this application and its contents with our employees and any outside agencies or representatives we deem appropriate. If there is anyone you do not want us to contact, please tell us in writing. 5. By signing below you are affirming that the statements you make in this application, plus any additional written and oral information you provide us about yourself (such as resume or interview) are true, and that you have not omitted anything about yourself that might be important to us in deciding whether to hire you. You understand that any false statement or material omission is sufficient grounds for us to reject this application or terminate your employment should you be hired.

Thank you!

Location

309 NE J Street | Bentonville | AR | 72712

Hours

Monday — Friday
7:00am — 6:00pm

Contact

(479) 273-3552