Application for Employment Application for Employment Position Applying For Location First Name Middle Name Last Name Address City State Zip Code Email Address Cell Phone Daytime Phone Evening Phone Have you ever used any other name which is necessary for us to know in order for us to verify your employment or educational record? Yes No Other Name Emergency Contact Person Relationship Phone Number How were you referred to us? Advertisement School Job Fair Company Reputation Internet Employment Agency Employee Referral Other (Specify) Name of any relative(s) currently employed by CLASS? Have you ever applied with us before? Yes No Previous Applied Date Have you ever worked for us before? Yes No Worked for us Date Are you currently employed? Yes No May we contact your present employer? Yes No Date available for employment Seeking: Full-time Part-time Temporary If offered employment, can you provide proof of authorization for employment in the United States? Yes No If employed, and under the age of 18, can you furnish a work permit? Yes No N/A Education High School Diploma/G.E.D. Received? Yes No End Section Name of College/Military/Trade School City/State # of Years Completed Major/Minor Degree/Certificate Recieved Name of College/Military/Trade School City/State # of Years Completed Major/Minor Degree/Certificate Recieved Name of College/Military/Trade School City/State # of Years Completed Major/Minor Degree/Certificate Recieved Name of College/Military/Trade School City/State # of Years Completed Major/Minor Degree/Certificate Recieved Work Experience Please specify your complete full-time and part-time employment history, including self-employment. You may include any verified work performed on a volunteer basis. Begin with your current or most recent employer. End Section Last/Present Employer Address Phone Numbers Job Title Supervisor Reason for Leaving Start Date End Date Work Performed Employer Address Phone Numbers Job Title Supervisor Reason for Leaving Start Date End Date Work Performed Employer Address Phone Numbers Job Title Supervisor Reason for Leaving Start Date End Date Work Performed Please explain any gaps in your employment Specialized Skills Specialized Skills End Section References Name Employer/Title Phone Number Phone Extension End Section Name Employer/Title Phone Number Phone Extension Name Employer/Title Phone Number Phone Extension This application is not finalized until it is fully completed, and all statements below have been read and acknowledged. End Section I certify that all of the information furnished in this application and during the application process is true, complete and correct to the best of my knowledge. I understand that any misrepresentation or omission of facts called for may result in refusal to hire or, if hired, may result in my dismissal at any time regardless of when the false answer or omissions are discovered. * I acknowledge the above statement. I recognize that this employment application is not an offer of employment. I agree that if I am hired by the Company, I will be an at-will employee, meaning that either the Company or I may end the employment relationship at any time with or without cause or notice. I understand that only the Executive Director, an no other employee has authority to enter into any agreement for employment or to make any agreement contrary to the at-will employment relationship for any specified period of time, and with respect to the Executive Director, any such agreements must be made in writing. * I acknowledge the above statement. I further understand and agree that, except for employment at-will status, if hired, my wages, hours, working conditions, job assignment(s), and compensation rate(s) may be subject to change by the Company. * I acknowledge the above statement. I understand that if I am offered employment, I may be required to sign a non-solicitation and non-disclosure agreement, as a condition of employment. * I acknowledge the above statement. I understand that the Company may share the information contained in this application with other Company employees for employment and administrative purposes and hereby consent to such transfer. * I acknowledge the above statement. I hereby authorize the Company to conduct any necessary investigation regarding my background (professional licenses, criminal records, driving history, earnings, and social security number) as it relates to the position I am seeking and to the extent permitted by federal, state, and local law. I agree to complete the requisite authorization forms for the background investigation. I hereby release all parties from any liability in connection with the provision and use of such information. * I acknowledge the above statement. I understand that the Company requires the successful completion of a TB Test as a condition of employment. By submitting this Application for Employment, I hereby consent to submit to such examinations and/or tests and hereby authorize release and disclosure of the results to the Company. * I acknowledge the above statement. I understand and expressly agree that if employed by the Company, storage areas provided for me (desk, file cabinet, etc.) are open to investigation by the Company without prior notice to me. * I acknowledge the above statement. I understand that any offer of employment is conditioned on my providing satisfactory proof of my identity and legal authority to work in the United States. * I acknowledge the above statement. I agree to be bound by the terms and conditions stated in this application, which contains all the understandings between the Company and me concerning the topics addressed herein, and supersedes any prior inconsistent understandings between the Company and me on such issues. * I acknowledge the above statement. reCAPTCHA If you are human, leave this field blank. Submit
