About you
We will use this to reach you about your application.
We do not ask for your Social Security number or driver's license here. Those are collected
only if we make you an offer, on the state background check form itself.
Screening
Required for anyone working in a licensed childcare program in North Carolina.
Certify and sign
I certify that I have given true, accurate, and complete information on this form to the best of my
knowledge. If confirmation is needed in connection with my work, I authorize educational institutions,
associations, registration and licensing boards, and others to furnish whatever detail is available
concerning my qualifications. I authorize investigation of all statements made in this application, and
I understand that false information or documentation, or a failure to disclose relevant information,
may be grounds for rejection of my application, disciplinary action, or dismissal if I am employed.
Large files can take a moment. If one will not upload we will still send your application and ask you for that file later.