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Cardinal Hayes Home for Children

About Us
Programs
Admissions
News
Employment
Contact

Employment Form New Test

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Cardinal Hayes Home for Children/ Hayes Day School Application 2026

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Personal Information: Cardinal Hayes Home for Children/ Hayes Day School is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of actual or perceived age, sex, gender identity or expression, sexual orientation, race, color, creed, religion, ethnicity, national origin, ancestry, alienage or citizenship, disability, military or veteran status, genetic information or any other legally recognized protected basis under federal, state or local laws, regulations or ordinances. Applicants with disabilities may be entitled to reasonable accommodation under the terms of the Americans with Disabilities Act and certain state or local laws. A reasonable accommodation is a change in the way things are normally done which will ensure an equal employment opportunity and will enable applicants to participate in the screening process and for employees to perform the essential functions of their jobs. We will provide reasonable accommodations to qualified individuals with disabilities as long as such accommodations do not impose undue hardship on Cardinal Hayes. Similarly, we will make reasonable accommodations to an applicant’s and employee’s religious beliefs and practices unless an undue hardship would result. Please let us know if you need assistance completing any forms or to otherwise participate in the application or selection process.

Todays Date(Required)

MM slash DD slash YYYY

Your Name(Required)

First Middle Initial Last

Present Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address(Required)

Enter Email Confirm Email

Are you over the age of 18?(Required)

Telephone No.(Required)

Are you legally eligible for employment in the USA?(Required)

If hired, your employment will be contingent upon verification of your eligibility to work in the United States. You will be required to complete Section 1 of Form I-9, Employment Eligibility required by the U.S. Department of Homeland Security, no later than the date of hire and to provide acceptable identity and employment eligibility document(s) within three days of hire. In the event you do not have, or cease to have, such documentation, all terms and conditions of any offer will be withdrawn and Cardinal Hayes shall have no liability of any sort whatsoever to you arising out of, or in connection with, any offer. If offered employment, you will be provided with a copy of Form I-9 plus a list of acceptable documents with the new hire package.

Do you have a valid driver’s license?(Required)

In what state?(Required)

Are you over the age of 21 (to meet the requirements of our Vehicle Insurance Policy)?(Required)

Position applying for:(Required)

Rate of pay expected per hour(Required)

Would you work (select all that apply):

Full Time

Part Time

Per Diem

1st Shift

2nd Shift

3rd Shift

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Were you previously employed by us?(Required)

If yes, when?

Who referred you? If nobody, please write N/A.(Required)

List any relatives or friends working for us:(Required)

List any relatives or friends living with us:(Required)

If your application is considered favorably, on what date will you be available to start work?

Are there any other experiences, skills or qualifications you feel would benefit you for work with our organization?

Record of Education

High School(Required)

Name and Address

Check Last Year Completed(Required)

1

2

3

4

Course of Study

Course of Study

Did you Graduate?(Required)

Yes

No

List Diploma or Degree

List Diploma or Degree

College

Name and Address

Check Last Year Completed

1

2

3

4

Course of Study

Course of Study

Did you Graduate?

Yes

No

List Diploma or Degree

List Diploma or Degree

Other

Name and Address

Check Last Year Completed

1

2

3

4

Course of Study

Course of Study

Did you Graduate?

Yes

No

List Diploma or Degree

List Diploma or Degree

Previous Employment

List below all present and past employment, beginning with your most recent employer.

Your Previous Employers(Required)

Employer

Address

Start Date

End Date

Position

Phone

Reason for Leaving

Supervisor and Title

Your Previous Employers

Employer

Address

Start Date

End Date

Position

Phone

Reason for Leaving

Supervisor and Title

Your Previous Employers

Employer

Address

Start Date

End Date

Position

Phone

Reason for Leaving

Supervisor and Title

When can we contact the employers listed above?(Required)

Immediately

Upon a conditional offer of employment

3 Personal References (All 3 Required)(Required)

(Do Not List Former Employers or Relatives - Teachers or Previous Co-workers preferred)

Name

Complete Email or Mailing Address

Phone Number

(Required)

Name

Complete Email or Mailing Address

Phone Number

(Required)

Name

Complete Email or Mailing Address

Phone Number

Cardinal Hayes Home

Milbrook, NY

BACKGROUND SCREENINGS: Section 424-a of the NYS Social Services Law requires clearance through OPWDD’s Criminal Background Check Unit, SEL, MHL 16.34 Statewide Central Registry, and others as required by New York State OPWDD and the Justice Center. Convictions and/or allegations do not automatically disqualify you from employment.

Disclosure of Information: By checking the box, I understand failure to disclose any information, or misrepresentations, will be considered falsification of this application.

I understand

Have you ever had a final determination made against you, such as “Indicated”, “Substantiated”, or “Confirmed” allegation of abuse, maltreatment or neglect by OPWDD, OCFS, Child Protective Services, Adult Protective Services, SED or any other agency?(Required)

Yes

No

If yes, then when? And please explain:

Have you ever been the subject of an indicated case of child abuse and maltreatment or convicted of sexual misconduct in any state?(Required)

Yes

No

If yes, then when? And please explain:

Were you ever, or are you now, excluded from participating in any State or Federal Programs such as Medicaid or Medicare due to fraud or any other violations?(Required)

Yes

No

If yes, please explain:

Have you ever been convicted of a misdemeanor or felony in any jurisdiction?(Required)

Yes

No

If yes, then when? And please explain:

Do you have any criminal charges pending?(Required)

Yes

No

If yes, please explain:

Have you been convicted of a moving violation within the last 3 years (including, but not limited to convictions involving alcohol and/or drugs while driving)?(Required)

Yes

No

Has your license been suspended or revoked in the last 3 years?(Required)

Yes

No

Have you been involved in a motor vehicle accident or occurrence involving harm to anyone or property while driving? (Please note harm to property can be as minor as hitting a guard rail or a street sign, another vehicle, minor accident, etc.)(Required)

Yes

No

If yes, describe in full:

In a short paragraph, briefly tell us why you are interested in working with individuals with developmental disabilities.

PLEASE AGREE TO THE FOLLOWING TERMS: The facts set forth in my application for employment are true and complete. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal. You are hereby authorized to make any investigation of my personal history, financial and credit record through any investigative or credit agencies or bureaus of your choice. In making this application for employment, I authorize you to make an investigative consumer report whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. This inquiry, if made, may include information as to my character, general reputation and personal characteristics. I expressly agree and understand that, if employed, my employment, is not for a specified term, is based upon mutual consent, and may be terminated at will, with or without cause or liability, by either party (Cardinal Hayes or me) without prior notice to the other. I also understand that this aspect of my employment may not change absent an individual written agreement signed by an authorized executive modifying at-will status. I expressly agree and understand that nothing in this application makes a binding or enforceable promise of specific treatment in specific situations. I understand that my employment will be based upon the outcome of background checks, successful completion of the agency’s orientation process and all reference checks. I am considered a temporary/provisional employee until the above is satisfied. (Revised 11.25.2025)(Required)

I agree to the terms and conditions.

Applicant Name(Required)

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