General Information

    General Information
    Emergency Contact
    Other Background


    High School
    Graduate School
    Other Education

    Employment Experience

    Employer #1
    Employer #2
    Employer #3
    Employer #4



    Additional Information

    Additional Information


    Reference #1
    Reference #2
    Reference #3
    Reference #4
    Read Carefully and Sign

    I hereby authorize Ebenezer Child Care Centers, Inc. to investigate my background, and verify all information which I provided in this application or otherwise. I release Ebenezer and its subsidiaries from any liability arising out of their investigation of my application for employment. I further authorize my past employers to share with Ebenezer any information concerning my employment that may be relevant to making an employ- ment decision, and release all parties from any liability for damage that may result from furnishing this information. I certify that this information and any supporting documents that I have provided or will provide to Ebenezer, whether oral or written, is correct to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of fact will constitute grounds for the rejection of my application, withdrawal of an offer of employment, or immediate dismissal from employment with Ebenezer regardless of when the falsification is discovered.

    I have read and understand each of the statements above, and sign this form in return for consideration for employment in the job specified.