Application for Employment

Transcription

1 Application for Employment Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodations to the application and/or interview process should notify a representative of the Company. Please Print Date of application / / Name LAST FIRST MIDDLE Address STREET CITY STATE ZIP address Home Telephone ( ) Mobile Telephone ( ) If necessary, best time to call: : Position applied for Type of employment desired: Full-time Part-time Temporary Salary Requirements Date Available Have you ever applied at this company before? YES NO If yes, give position and date:. / / Have you ever been employed here before YES NO If yes, give dates From / / To / / If required, will you work overtime? Yes No If unable to work overtime, if required, please explain: Are you able to perform the essential functions of this job without accommodations? YES NO Are there other names which you have worked or attended school? YES NO If yes, please list for reference checking purpose: Are you legally authorized to work in the US? YES NO (If hired, you will be required to provide proof of work authorization.)

2 Note: Answering YES to the following questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account. You are obligated to disclose sealed or expunged records of conviction or arrest or expunged juvenile records of conviction or arrest. Have you ever pled guilty or no contest to, or been convicted of a felony, misdemeanor or other offense other than a minor traffic violation? YES NO Have you ever received a citation for driving under the influence of alcohol? YES NO SINCE DRIVING MAY BE REQUESTED OF ANY EMPLOYEE, PLEASE COMPLETE THE FOLLOWING: Driver s License Number State Issued Exp Date Glenwood Academy will make reasonable efforts to safeguard the privacy of this information and will use it only for employment purposes. Has your license ever been revoked or suspended? YES NO Employment Experience: Place an X by the employer(s) you DO NOT want us to contact. List your most recent employer first. If this does not cover your activity (employment or volunteer work) for the last 15 years, please attach an additional sheet containing that information. Dates employed: from (mm/yy) to (mm/yy) Hourly rate/salary: starting final 2

3 Dates employed: from (mm/yy) to (mm/yy) Hourly rate/salary: starting final Dates employed: from (mm/yy) to (mm/yy) Hourly rate/salary: starting final Education Background: High School city, state College city, state 3

4 Graduate School city, state Vocational Training / Other city, state Continuing Education city, state Special Skills and Qualifications Summarize any special training, skills, licenses and /or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying. References List name, addresses, and telephone of three business/ work references that are not related to you. Name Address City State Zip Code Telephone No. Years Known 4

5 Applicant Statement and Release I certify that all information I have provided in order to apply for and secure work with Glenwood Academy (hereafter referred to as the School ) is true, complete and correct to the best of my knowledge and belief. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration of employment or (ii) may result in my immediate discharge from the employer s service, whenever it is discovered. I expressly authorize without reservation, the School, its representative, employees or agents to contact and obtain information from all references, employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that the School does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law. Regardless of whether or not I become employed by the company, I recognize this application is not and should not be considered an agreement contract of employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurance to the contrary and that no implied oral or written agreement contrary to the foregoing express language are valid unless they are in written and signed by the employer s President/CEO. If I am hired, I understand that I am free to resign at any time with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. As a condition of employment, I hereby agree, voluntarily and of my own free will, without duress or coercion, to submit to alcohol and drug testing as part of the pre-employment physical examination. Such testing will occur as a precondition to my being employed, or anytime during my employment with this company when there is (a) reasonable cause to believe that violation of the Alcohol and Drug Policy exists or (b) as part of a random testing of employees. Additionally, I authorize any physician or hospital to relay any information to the School, which may be necessary to determine my ability to perform the duties of the job for which I am applying after a conditional offer of employment has been made. I further understand that an offer of employment will be contingent upon my ability to successfully complete and pass an employee health exam including TB and drug tests. I understand refusal to submit to such testing or my failure to successfully complete such testing may result in the School not hiring me or will result in my termination of employment. By signing this consent and release I release and waive any rights or claims, which I or anyone claiming through me may have now, or in the future, against the School, its employees, officers, and agents, arising out of relating to such testing. DO NOT SIGN UNTIL YOU HAVE READ CAREFULLY THE ABOVE APPLICATION STATEMENT I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement and Release. Signature of Applicant Date / / Glenwood Academy is an Equal Opportunity Employer 5