EMPLOYMENT APPLICATION

AN EQUAL OPPORTUNITY EMPLOYER
EduKid's policy prohibits discrimination on the basis of race, color, national origin, gender, age, religion, creed, marital status, military service, arrest or conviction record, handicap or disability, citizenship, or any other legally protected status in accordance with all applicable federal and state laws.
Date:
Name:
Address: City: State: Zip:
How long at current address? Telephone Number:
Position Applied For:
Full or Part Time? Salary Range Desired:
Location Preference: Date available for work:
If under age 18, do you have a work permit? Yes No
If you are not a United States Citizen, do you have the legal right to work in the United States? Yes No
Please explain any disability you have which would substantially interfere with your ability to perform the essential functions of the job for which you have applied?
Have you been convicted of a crime in the past ten years? Yes No
(Conviction will not necessarily disqualify an applicant from employment)
Dates of Previous Employment with EduKids:
List the names of any relatives employed by EduKids:
How were you referred to EduKids?
In case of emergency, notify:
Name:
Address:
Telephone Number:

EDUCATIONAL BACKGROUND

SCHOOL NAME
MAJOR
DEGREE?
YES
NO
HIGH SCHOOL
COLLEGE
GRADUATE
OTHER
PROFESSIONAL
LICENSURE OR
CERTIFICATION
(Please include
CPR/First Aid
Certification and
Expiration Date)

EMPLOYMENT BACKGROUND (List the names of all your employers starting with current or most recent.)

Company Name: Dates Employed:
Address: Salary Starting: Ending:
Job Title: Telephone #:
Name of Supervisor: Reason for Leaving:
Company Name: Dates Employed:
Address: Salary Starting: Ending:
Job Title: Telephone #:
Name of Supervisor: Reason for Leaving:
Company Name: Dates Employed:
Address: Salary Starting: Ending:
Job Title: Telephone #:
Name of Supervisor: Reason for Leaving:

REFERENCES (Please provide the name, address, and telephone number of three references who are qualified to evaluate your capabilities and who are not related to you.

NAME
ADDRESS
TELEPHONE #

APPLICANT'S STATEMENT
I understand that if I am employed, employment is at-will and may be terminated at any time without cause or notice.
A routine inquiry may be made which will provide information concerning your job background and qualifications for available
positions. Upon written request, information as to the nature and scope of the report, if one is provided, will be made available
to you.

I certify the information I have given is accurate and complete to the best of my knowledge. I authorize you to process my
application. I further understand that if I am employed, any misrepresentation of facts on this application is sufficient cause
for dismissal.

By typing your name and today's date in the areas below, you acknowledge and agree to the preceeding statement.

Signed: Date:

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