Application for Employment
Write your copy here.

Place your photo here.

______________________________                             _____________________________
First Name     Last Name


Discovery is a full-service, quality-learning center. Discovery is individually owned and operated by a family such as
your own who wish to provide parents with quality childcare. At Discovery, we teach the often underestimated art of
quality child care along with the needs and expectations of parents and children.  If employed, you will be expected to
perform at the level that rates among the highest. We will give you the tools and the training you need to perform at
your peak. Thank you for considering Discovery for your employment needs.

Discovery is an equal opportunity employer. In all our employment practices, including hiring, we are firmly
committed to equal opportunity without regard to race, religion, color, sex, age, national origin, citizenship, disability or
any other basis of discrimination prohibited by applicable local, state or federal law. No question on this application is
used for the purpose of limiting or excluding any applicant’s consideration for employment on such grounds.

As an applicant for a position at Discovery, I certify to the following:
1. I am able to perform adequately the job duties for which I am applying.
2. I do not have a criminal record.
3. I have never abused, neglected or deprived a child or adult or subjected any person to serious injury as a result of
intentional or grossly negligent misconduct.
4. I will comply with all state requirements for initial and continued certification.

Applicant Signature: ______________________________________ Date: _________

Discovery does not hire persons who use illegal drugs. Persons hired may be required to take and pass a strict screen
for illegal drugs and may be subject to periodic tests for illegal drugs.

I certify that I (check one) do______ do not__________ use illegal drugs.

Applicant Signature: ______________________________________ Date: _________

irst Name _____________________________ Middle__________________ Last_____________________________

Address _______________________________________________ City ___________________ State_____ Zip ______
Home Phone (___) ___________________ Cell Phone (___) _______________ Other Contact Phone ______________________

Are you or have you been known by a different name, if so, please indicate: _____________________________________________
Have you ever applied for employment or been employed at Discovery? Yes / No
Do you have any relatives or friends working at any Discovery? Yes / No
Have you ever been convicted of a crime? Yes / No
Have you ever served in any branch of the United States armed forces? Yes / No
Are you currently on layoff status, leave of absence or other suspension of
employment and subject to recall with another employer? Yes / No
If you answered YES to any of the above, include details below:

Are you at least 18 Years of Age? Yes/ No

How did you hear about us? Friend/Relative____ Drive-By____ Internet___ Other ___________________

Name City/State Years Degree Area of Study

High School _________________ _____________ _______ __________ _________________

College _________________ _____________ _______ __________ _________________

Trade/Vocational _________________ _____________ _______ __________ _________________

Are you current in First Aid or CPR training? _______________________________

Do you hold any certificates in Child Care Training?_________________________
Please list three personal references that do not include previous employers, ministers or relatives:

Name _______________________________________ Phone (____) _____________ Occupation _______________________

Name _______________________________________ Phone (____) _____________ Occupation _______________________

Name _______________________________________ Phone (____) _____________ Occupation _______________________

What position are you applying for?  Lead Teacher     Asst Teacher      Cook     

Employment desired? Full Time /  Part Time Hours ______________________________________

Preferred Age Group?   Infants    Ones   Twos   Threes   Fours   After-School

Salary Expected : $ _________ per hour

List each job held, starting with the most current. Explain any gaps in the space below.
Please explain any employment gaps.
List any other experience or training that would be applicable to your application:
Do you have access to reliable transportation? Yes / No
Do you have any children that might attend Discovery? Yes / No Ages: __________________________
We offer a discounted rate for fulltime employees.
Would you be willing to participate in training programs for teachers? Yes / No
Are you involved in any activities that would affect your attendance? Yes / No List __________________

Discovery has a strict no smoking policy, which includes the parking lot and bus.

Dates of Employment____________________Company Name_______________________________Job Title______________


Starting Pay___________Ending Pay____________Address_____________________________________________

Supervisor_________________________________Phone #________________________Reason for Leaving_______________________________________

Dates of Employment_____________________Company Name______________________________Job Title _________________________


Starting Pay___________Ending Pay_____________Address________________________________________________

Supervisor_________________________Phone #________________________Reason for Leaving_________________________________________________

Dates of Employment______________________Company Name_____________________________Job Title___________________


Starting Pay____________Ending Pay_____________Address_________________________________________________

Supervisor___________________________Phone #______________________Reason for Leaving_______________________________

Dates of Employment______________________Company Name_____________________________Job Title____________


Starting Pay_____________Ending Pay______________Address_________________________________________________

Supervisor____________________________Phone #______________________Reason for Leaving___________________________

Please read the following carefully and sign in the space provided.
I hereby certify that the facts set forth in this application (and accompanying resume) are true and complete to the best
of my knowledge. I agree and understand that any misrepresentation of information or failure to disclose information
during the employment process may disqualify me from further consideration for employment and if employed, will
subject me to dismissal. If I am offered employment, I understand I may be required to submit to a physical
examination designed to determine whether I am able, with or without reasonable accommodation, to perform the
essential functions of the job offered, as specified by Discovery, and that final acceptance for employment is subject to
me successfully passing this physical examination. I further understand that any misrepresentation of information or
failure to disclose information at the time of my physical may result in employment disqualification or dismissal.
I understand that in connection with my application for employment, an inquiry into my background may include an
investigative consumer report, which provides applicable information concerning character, general reputation, personal
characteristics and mode of living. I understand that I have the right to make a written request within a reasonable
period of time for information as to the nature and scope of any such report.
If employed, I agree to conform to all Discovery rules and regulations and all Federal, State and local rules and
regulations. In this regard, I understand that Discovery may, at it’s discretion, conduct searches of lockers, lunch
boxes, tool boxes, clothing, purses, briefcases, vehicles, desks, work areas and other personal or Discovery property,
and I hereby consent to such search. I also understand that if employed, my employment is for an indefinite period of
time, that either Discovery or I may terminate my employment at will at any time, with or without cause or notice.
I hereby disclaim the existence of any contract of employment, either express or implied.

This Agreement contains and represents the entire agreement between Discovery and me concerning the topics
discussed herein. There are no oral or collateral agreements of any kind concerning such topics. I further understand
that this Agreement cannot be orally modified and that any subsequent modification of this Agreement including the
at-will state of employment I seek, must be in writing and duly executed by Discovery.
I certify that I am a true and bona fide job applicant honestly interested in the positions for which I have applied, and
am seeking employment with Discovery solely to provide me the benefits of a job and for no other purpose.

Applicant Signature: ______________________________________ Date: _________________

I understand Discovery and its agents may investigate or seek information concerning my background and/or previous
employment. I further agree and understand that if employed, Discovery may at any time seek any information from
whatever source, which, in its discretion, deems relevant to my employment. Accordingly, I hereby authorize the
previous employers and references listed in my application, any medical facility or related personnel, or any other source
contacted by Discovery to give Discovery any and all information they may have, personal or otherwise. I hereby release
Discovery and it’s agents, any previous employers, any medical facility or related personnel, any other persons or entities
whatsoever involved in such an investigation or inquiry from all liability of any kind, including any damages on account of the furnishing of
such information.
I further understand that my Criminal Records, Felony Background Check, and Background Check for Child Abuse &
Neglect, will be sent in on the date of hire and my employment at Discovery may be terminated if my records check is not
in compliance with State and Child Care standards. I also understand that my previous employment and my personal
references will be checked.

Applicant Signature: ______________________________________ Date: _________
Discovery  Learning Center

(605) 274-3475 We will see you soon!