Position(s) applied for: TeacherAssistant TeacherAideKitchen Technician
Date of application
Your Name (required)
Address
Phone Number (required)
Your Email (required)
Are you 16 years of age or older?: YesNo
Have you applied with us in the past?: YesNo
Have you been employed with us in the past?: YesNo
Are you currently employed? YesNo
May we contact your current employer? YesNo
Are you prevented from being lawfully employed in the US because of Visa or immigration status? Proof of citizenship or immigration status will be required upon employment YesNo
What is your work availability? Full TimePart TimeSubstituteSeasonal
Have you been convicted of a felony within the last 7 years? Conviction will not necessarily disqualify an applicant from employment YesNo
If yes, please explain:
Name of High School:
Address of High School:
Did you graduate? YesNo
Name of Vocational College:
Address of Vocational College:
Check years completed: 1234
List Degree:
Name of Undergraduate College:
Address of Undergraduate College:
Name of Graduate School:
Address of Graduate School:
Indicate any foreign languages you can speak, read, and/or write:
Training source:
Are you currently certified? YesNo
Date:
Number of hours:
Describe any specialized training, workshops, seminars, internships, skills or extra-curricular activities:
Dates employed:
Job title:
Work performed:
Supervisor's name:
Employer's address:
Employer's phone number:
Starting pay:
Ending pay:
List professional, business, or civic activities and offices held: You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.
Summarize special job-related skills and qualifications acquired from employment or other experiences:
State any additional information you feel may be helpful to us in considering your application:
Name:
Phone number:
Relationship to you:
Do not answer this question unless you have been informed about the requirements of the job for which you are applying.
Are you capable of performing in a reasonable manner, with or without reasonable accommodation, the activities involved in the job for which you have applied? A description of the activities involved should be available with this application. YesNo
I certify that the answers given are true and complete to the best of my knowledge. I authorize the investigation of all statements in this application for employment as may be necessary in arriving at an employment decision. I understand and acknowledge that, unless defined be applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without any written document or by conduct unless such changes is specifically acknowledged in writing by an authorized executive of this organization. I also understand that any offer of employment will be conditional upon my successful completion of a state Applicant Background Study and documentation of my credentials, work experience, and accredited child development training courses necessary to verify with Department of Human Services licensing requirements. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. Type name to sign: (required)
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