Name
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First Name
Last Name
Email
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Phone
(###)
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Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Are you at least 18 years of age?
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Do you have any immediate family members who currently work or have worked at HWCEC?
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Do you speak a language other than English? If so, please share.
What position are you applying for?
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Infant/Toddler Teacher
Preschool Teacher
Part-time
Administrative
Management
Facilities
Available start date
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MM
DD
YYYY
Are there any days or times you are not available to work?
Highest level of education completed
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GED
High School Diploma
Associate's Degree
Bachelor's Degree
Master's Degree
None of the above
Field of Study
College Education (Select all that apply)
Which of the following trainings or certifications have you completed? (Select all that apply)
Approximate number of completed training hours in Early Childhood:
Have you worked for HWCEC before?
If yes, what was your end date:
MM
DD
YYYY
If yes, what was your end date:
MM
DD
YYYY
May we contact your current employer?
Employer Name
Supervisor Name & Title
Employer Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Employer Phone Number
(###)
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Employment Start Date
MM
DD
YYYY
Employment End Date
MM
DD
YYYY
Position(s) Held
Starting and Ending Salary
Job Duties
Reason for Leaving
Employer Name
Supervisor Name & Title
Employer Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Employer Phone Number
(###)
###
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Employment Start Date
MM
DD
YYYY
Employment End Date
MM
DD
YYYY
Position(s) Held
Starting and Ending Salary
Job Duties
Reason for Leaving
Employer Name
Supervisor Name & Title
Employer Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Employer Phone Number
(###)
###
####
Employment Start Date
MM
DD
YYYY
Employment End Date
MM
DD
YYYY
Position(s) Held
Starting and Ending Salary
Job Duties
Reason for Leaving
Do you have documentation of an Annual TB Skin Test?
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Do you have documentation of an recent DTAP Vaccine?
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Are you authorized to work in the United States?
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Would you like your application shared with other relevant opportunities if this position is not available?
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By checking below, you acknowledge and consent to a pre-employment drug screening. A positive result for illegal substances may disqualify you from employment.
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Have you ever been denied parental or custodial rights due to child maltreatment?
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Have you lived outside of Arkansas in the past six years?
Have you ever been convicted of any of the serious offenses listed below?
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
By checking below, you authorize HWCEC to obtain a criminal background report and FBI fingerprinting as part of the hiring process.
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I acknowledge and agree to the terms above.
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