Employment History Review

According to MSDE Guidance for Md. Code, Educ. §6-113.2 Child Sexual Abuse and Sexual Misconduct Prevention, the law requires a nonpublic school to require an applicant for a position involving direct contact with minors to submit the contact information of the current employer, all former school employers, and all former employers of the applicant in which the applicant was employed in a position involving direct contact with minors within the previous 10 years. Within 20 days of receiving a request from a prospective employer, a current or former employer shall send the information required and complete the form approved by the MSDE.

Aya will send the applicant a copy of the form to complete and sign, then will email it to each employer listed.

Applicant's Name

First Name

Last Name

Any former names by which the Applicant has been identified:

First Name

Last Name

Applicant's Date of Birth

YYYY

Applicant's Last 4 digits of your social security

NO PRIOR EMPLOYMENT?

If you have NOT worked with any employer that involved working with minors in the last 10 years, please check this box

Line

Employer 1: Name of Current or Former Employer:

The employer can be a school or an organization or a person

Employer 1: Position Held by Applicant at this organization (YOU)

Employer 1: Dates of Employment

from _ to _

Employer 1: Contact Person + Title/Position

Supervisor or HR. Aya will send the form to this person

Employer 1: Email Address of the Contact Person

Line

Employer 2: Name of Current or Former Employer:

The employer can be a school or an organization or a person

Employer 2: Position Held by Applicant at this organization (YOU)

Employer 2: Dates of Employment

from _ to _

Employer 2: Contact Person + Title/Position

Supervisor or HR. Aya will send the form to this person

Employer 2: Email Address of the Contact Person

Line

Employer 3: If you worked with more than 2 employers that involved working with minors in the past 10 years, please add their information here

Employment History Review

Campuses

Programs

Info