Employment Application CCCEC
Complete this form to apply for positions within our company. Completed applications are reviewed for criteria matching open positions. 
Email *
First and last name *
Address *
Phone number - This is the method of communication for reaching out to applicants.  *
Are you seeking full time or part time employment?
Clear selection
CCCEC has employment opportunities in a variety of areas. Please indicate your areas of interest. Check all that apply.  *
Required
List any professional licenses or degrees relevant to the position. Single line text.
List work experience for the past 6 years, beginning with most recent employer. You may include volunteer or unpaid positions. Provide name of employer, position, and phone number. If none, type in N/A.
*
Do you have any relatives employed by CCCEC?
*
Required
Provide at least three references we may contact. Provide name and phone number for each.
What is your highest level of completed education?  *
I understand CCCEC is required to do criminal, FBI, child maltreatment, adult maltreatment, and sex offender registry checks on all staff. All checks must be clear prior to employment offer.
*

I understand CCCEC does pre-employment and random drug screens.

*
Tell us about special skills you have that help us to get to know you.
How did you hear about us?
I understand that completion of this application is an not entry into an employment relationship. I authorize investigation of all statement contained in this application. I understand that the misrepresentation of omission of facts called for is cause for dismissal at any time with or without previous notice. I hereby give CCCEC permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release CCCEC from any liability as a result of such contract. I understand that some jobs may require an acceptable driver's record. I understand that CCCEC completes regulatory checks before hire, and if employment is offered, subsequent regulatory checks will be completed as determined by licensure. If regulatory checks are not approved, it will be reason for immediate dismissal. I understand that I will be required to provide proof of eligibility to work in the United States pursuant to the Immigration Reform And Control Act of 1986 as a condition of my employment. I understand that my application may be subject to disclosure as a public record under the Arkansas Freedom of Information Act. 
By signing below, I understand the above statements, and I hereby declare that to the best of my knowledge and ability, the information on the application is factual and true. 
*

Enter today's date. The application will stay active for up to 6 months.
*
MM
/
DD
/
YYYY
A copy of your responses will be emailed to .
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Conway County Center for Exceptional Children.

Does this form look suspicious? Report