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• The applicant’s completed Background Information Disclosure form and fee • A copy of the applicant’s social security card and picture identification • A copy of the applicant’s training certificates for Sudden Infant Death Syndrome, Shaken Baby Syndrome and 5 hours of continuing education per year – Fundamental of Family Child Care and Introduction to Child Care Profession – if applicable • Applicant’s TB test – if applicable • Applicant’s working hours • New Hire report – if applicable • W9 with a copy of FEIN attached from the IRS – if applicable • Worker’s Comp Insurance – if applicable • Wages reported to Unemployment – if applicable • Proof of substitute orientation – if applicable
• By signature, I signify a willingness to provide MECA with information to verify whether or not the requirements for this application are met and further authorize MECA to make such investigations as is necessary for verification of these factors including access to premises any time during hours of operation. • I affirm that all statements made in this application and any attachments are true and correct to the best of my knowledge. I understand that failure to submit correct or truthful information or omitting information now and in the future is grounds for sanctions under the authority of applicable statutes and or administrative codes. Credible statements made to the agency that contradict information I provide under my written testimony may also be grounds for denial of me as an assistant, employee, substitute or volunteer I understand all of the questions and statements on this application form.
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