Employment Application - Positive Behavior Support Assistant - The Denise Louie Education CenterThe Denise Louie Education Center

Employment Application – Positive Behavior Support Assistant

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Please complete the following online application for this position. In addition, you will have the opportunity to attach your resume and/or cover letter.

For which position are you applying?*
Name*

First

Last
Address*

Street Address

Address Line 2

City

State

ZIP Code
Phone*
Email*
Expected Salary*
Do You Have A Current*
- Tubercular Test Result?*
- Physical Exam**
- Immunizations
- Food Handler’s Permit?
- First Aid Card?
- Cardiopulmonary Resuscitation Card?
- Washington State Driver’s License?
- HIV/Blood Born Pathogen’s Training?
* Required for all positions prior to start.

** Required for all positions prior to start. DLEC will also accept physical exams that were complete 6 months prior to start. Physical examination information is required to ensure the health and safety of children, staff and families. DLEC does not discriminate based on physical exam results. Consistent with the Americans with Disabilities Act, DLEC will make reasonable accommodations upon request.
Education
School Attended
City & State
Graduated
- Yes
- No
Degree
Major
School Attended
City & State
Graduated
- Yes
- No
Degree
Major
School Attended
City & State
Graduated
- Yes
- No
Degree
Major
Employment History

Please list related previous employment starting with the most recent.
Employer
Employer Address

Street Address

City

State

ZIP Code
Phone
Reason for leaving
From
To
Job Title / Duties
Employer
Employer Address

Street Address

City

State

ZIP Code
Phone
Reason for leaving
From
To
Job Title / Duties
Employer
Employer Address

Street Address

City

State

ZIP Code
Phone
Reason for leaving
From
To
Job Title / Duties
Training & Workshops

Please list other training, workshops or certifications you’ve completed relating to position being applied for.
Course Title Date Hours
Criminal Background

Please complete the following questions. Do not leave blank, please write “N/A” if not applicable. This information is required by child care licensing and Head Start Performance Standards; and will be verified through a criminal background check prior to hire.

Applications received with this section incomplete will not be considered.
Please list all pending and prior criminal arrests and charges related to child sexual abuse and their disposition*
Please list all convictions related to other forms of child abuse and neglect*
Please list all convictions for violent felonies*
Additional Information

Please complete the following questions. Do not leave blank, please write “N/A” if not applicable.
Are you a former or current Head Start/ECEAP parent?*
- Yes
- No
Do you speak or write other language than English?*
- Yes
- No
List any languages other than English that you can speak or write.*
References

Please list three references including at least one professional reference. Do not include names of people that are related to you by blood or marriage.
Name

First

Last
Work Phone
Home Phone
Address

Street Address

Address Line 2

City

State

ZIP Code
Relationship
Name

First

Last
Work Phone
Home Phone
Address

Street Address

Address Line 2

City

State

ZIP Code
Relationship
Name

First

Last
Work Phone
Home Phone
Address

Street Address

Address Line 2

City

State

ZIP Code
Relationship
Cover Letter and Resume
Drop files here or
Provide a cover letter and resume to complete your application.
Certification*
I understand that a condition of employment is that Denise Louie Education Center must conduct local and national background checks. Therefore, if offered employment by Denise Louie Education Center I hereby authorize Denise Louie Education Center to conduct local and national background checks for the purposes of evaluating whether I am qualified for the position. I understand that Denise Louie Education Center will utilize an outside firm(s) to assist in checking such information. I also understand that I may withhold my permission and in such a case my application for employment will not be processed further.
- I agree that Denise Louie Education Center may conduct a local & national background check in the event of hire.
If employed, the employment relationship between me and Denise Louie Education Center will be at-will. This means that the employment relationship is for no specific term and may be terminated by either me or Denise Louie Education Center at any time, with or without cause or advance notice, for any reason not prohibited by law. Nothing contained in the DLEC Policies & Procedures or descriptions of benefits create a contract between you and DLEC for continued employment or any particular benefit. While employed by the organization, I agree to devote my business and professional time and energy to the conduct of the organization’s business and not devote substantial business or professional services to other interests without prior agreement.
I certify that the above is true and correct to the best of my knowledge. I understand that any untrue or misleading answers are cause for rejection of my application or dismissal if employed. I authorize Denise Louie Education Center to verify statements contained in this application. I authorize Denise Louie Education Center to contact references listed in this application. I further authorize the release of information related to my employment for consideration in making a hiring decision and hold the person(s) and the corporation(s) giving references harmless and free of any and all liability that could result from this process.

More than 400,000 children in Washington, or 25 percent, live in households where there’s not enough food for everyone to eat.

Hungry in Washington November 2010.” Children’s Alliance. N.p., 8 Sept. 2011. Web. 4 Mar. 2013.

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Employment Application – Positive Behavior Support Assistant

Education

Employment History

Training & Workshops

Criminal Background

Applications received with this section incomplete will not be considered.

Additional Information

References

More than 400,000 children in Washington, or 25 percent, live in households where there’s not enough food for everyone to eat.

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Employment Application – Positive Behavior Support Assistant

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Education

Employment History

Training & Workshops

Criminal Background

Applications received with this section incomplete will not be considered.

Additional Information

References

More than 400,000 children in Washington, or 25 percent, live in households where there’s not enough food for everyone to eat.