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Greenbush Child Caring Employment Application


Employment Desired

Please select the appropriate answer for each question:

If hired, you will be required to produce proof of eligibility to work in the United States in accordance with the Immigration Reform and Control Act of 1986.
You need not disclose information that has been sealed, expunged, or pardoned, or adjudications with youthful offender status.

Please select the days and hours you are available to work (Please select at least one)

Education History

Employment History
(Please complete the following in its entirety, regardless of attaching a resume)

Current/Most Recent Employer
Previous Employment

Attendance and Punctuality Information

Consistent attendance and punctuality are essential requirements of every job with this company and our Clients.

Please Review and Sign the Following:

 I authorize investigation of all statements contained herein, and the references and employers listed to give you any and all information concerning my previous employment and any pertinent information that they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I will hold Greenbush Child Caring, Inc. harmless from any claims including, but not limited to, personal injury or illness as a result of false or mislead ing information on this application

 This waiver does not permit the release or use of disability related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) or other relevant federal and state laws.

 I authorize you to communicate with persons listed as references, former employers, and any other with whom you desire to check. I agree to hold such persons harmless with respect to any information they may give about me.

 I understand that completion of this Application for Employment does not guarantee that I have been employed by Greenbush Child Caring, Inc.

 I hereby affirm that my answers to these statements and questions are true and correct to the best of my knowledge. I have not knowingly withheld any fact or circumstance that would, if disclosed, affect my application unfavorably. I understand that any misrepresentation, deception, omission, or false statement made in this Employment Application may result in my not being considered for employme nt, and if not discovered by Greenbush Child Caring, Inc. until after my becoming employed, is grounds for, and may result in, my immediate termination.

 My employment is “at will”, and as such, may be terminated by Greenbush Child Caring, Inc. or myself at any time with or without notice. No representative of the company has the authority to enter into any agreement for employment for a specific period of time, or to make any agreement contrary to the foregoing, unless in writing and signed by the administration of Greenbush Child Caring, Inc. Greenbush Child Caring, Inc. will only be responsible for wages earned up to the point of my termination.

 I hereby authorize the educational institutions listed on the Employment Application to release a copy of my official transcript of my academic record.

 I understand that Greenbush Child Caring, Inc. is a drug free workplace. I agree to work under the conditions requiring a drug free workplace consistent with applicable federal, state, and local law.

 I certify that all the information on this application, my resume, or any supporting documents is complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualifica tion from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal.

 I authorize Greenbush Child Caring, Inc. to confirm all statements contained in this application and/or resume as it relates to the position I am seeking and to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization forms for the background investigation.

 I authorize and consent to, without reservation, any party or agency contacted by Greenbush Child Caring, Inc. to furnish the above mentioned information. I hereby release, discharge and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to Greenbush Child Caring, Inc. pursuant to this authorization form any liability, claims, charges, or causes of action which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability Greenbush Child Caring, Inc. for seeking such information and all other persons, corporations, or organizations furnishing such information.

 If hired by Greenbush Child Caring, Inc., I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States. I also understand Greenbush Child Caring, Inc. employs only individuals who are legally eligible to work in the United States

Greenbush Child Caring Inc. Info

Greenbush Child Caring, Inc.
620 Columbia Turnpike
East Greenbush, NY 12061

Phone (518) 477-4125
Fax (518) 479-4240

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