Application for Employment 
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______________________________                             _____________________________ 
First Name     Last Name 


APPLICATION FOR EMPLOYMENT 
AN EQUAL OPPORTUNITY EMPLOYER 



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______________

Responsibilities___________________________________________________________________________________________

Starting Pay___________Ending Pay____________Address_____________________________________________

Supervisor_________________________________Phone #________________________Reason for Leaving_______________________________________


Dates of Employment_____________________Company Name______________________________Job Title _________________________

Responsibilities____________________________________________________________________________________________

Starting Pay___________Ending Pay_____________Address________________________________________________

Supervisor_________________________Phone #________________________Reason for Leaving_________________________________________________

Dates of Employment______________________Company Name_____________________________Job Title___________________

Responsibilities_____________________________________________________________________________________________

Starting Pay____________Ending Pay_____________Address_________________________________________________

Supervisor___________________________Phone #______________________Reason for Leaving_______________________________


Dates of Employment______________________Company Name_____________________________Job Title____________

Responsibilities___________________________________________________________________________________________

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

INTRODUCTION
EQUAL OPPORTUNITY POLICY
APPLICANT'S CERTIFICATION
DRUG POLICY
PERSONAL INFORMATION
EDUCATION
POSITIONS APPLYING FOR
PREVIOUS EMPLOYMENT
AGREEMENT and CERTIFICATION
AUTHORIZATION TO RELEASE INFORMATION
(605) 274-3475 We will see you soon!