Employment Application – Love & Learn Preschool Academy

Love & Learn Preschool is an equal opportunity employer. Applicants are considered for employment without regard to race, color, religion, sex, age, disability, national origin, or any other basis prohibited by law, unless such basis constitutes a bona fide occupational qualification. Love & Learn Preschool will comply with its legal obligation to provide reasonable accommodation to
qualified individuals with disabilities.

Date of Application

Social Security Number

First Name

Middle Name

Last Name

Address

City

State

Zip Code

Phone

If you have resided at your present address less than three years, list your prior address:

Address

City

State

Zip Code

Position(s) Desired

Salary Expected

Are you availabe to work:

On what date would you be available for work?

Are you on a layoff and subject to recall at another employer?

Yes

No

Have you filed an application here before?

Yes

No

If yes, give date(s)

Have you ever been employed here before?

Yes

No

If yes, give date(s)

Why did you apply for a position at Love & Learn Preschool?

Why do you think you would make a valuable employee of Love & Learn Preschool?

Are you legally authorized to work in the United States?

Yes

No

Will you now or in the future require sponsorship for employment visa status (e.g., H-1B visa status)?

Yes

No

Are you 18 years or older?

Yes

No

Have you been convicted of or pled guilty to a felony or misdemeanor other than a minor traffic-related infraction?

Yes

No

(A conviction or plea will not necessarily disqualify you from consideration for employment. The effect of a conviction will be assessed with respect to time, circumstances, seriousness of the offense, and job responsibilities and duties. However, your failure to list a conviction will disqualify you from consideration for employment or will result in termination of employment if subsequently discovered.)

If yes, state the nature of the conviction or plea, the date, and explain

Name of person to notify in case of emergency

Address

Emergency Phone Number

Education

High School Name

City/State

Number of Years Completed

Graduate?

Yes

No

College or University

City/State

Number of Years Completed

Graduate?

Yes

No

College Course Pursued / Degrees Granted

Business, Trade, Technical, or Correspondence School or College

City/State

Number of Years Completed

Graduate?

Yes

No

Course Pursued / Degrees Granted

List any special job-related skills, software, certifications and qualifications acquired from education, employment, volunteer work or military service.

List specific skills or office machines, tools, machinery or other equipment that you are trained on and can operate that will be helpful in performing the responsibilities of the position(s) for which you are applying

Personal References

Name

Email Address

Phone Number

Name

Email Address

Phone Number

Name

Email Address

Phone Number

Employment Record

Employer

Employment Start Date

Employment End Date

Employer Address

Employer Phone Number

Job Title

Immediate Supervisor

Job Duties

Employer

Employment Start Date

Employment End Date

Employer Address

Employer Phone Number

Job Title

Immediate Supervisor

Job Duties

Employer

Employment Start Date

Employment End Date

Employer Address

Employer Phone Number

Job Title

Immediate Supervisor

Job Duties

Employer

Employment Start Date

Employment End Date

Employer Address

Employer Phone Number

Job Title

Immediate Supervisor

Job Duties

May we contact the employers listed above?

Yes

No

If no, indicate which one(s) you do NOT wish us to contact and state the reason why you prefer that we do not contact the employer(s).

Have you ever been discharged, permitted to resign rather than be discharged, or asked to resign from any position?

Yes

No

If yes, please state the employer, and the reason for the discharge or resignation

Which of your previous jobs have you liked best?

Why?

Which of your previous jobs have you liked least?

Why?

APPLICANT’S STATEMENT

I certify that this application was completed by me and that all entries and information in it are TRUE and COMPLETE to
the best of my knowledge. I understand that false, misleading or omitted information in my application may result in the
rejection of my application, the revocation of an offer of employment, or discharge.

I authorize investigation of all statements contained in this application as may be necessary in arriving at an employment
decision. I understand that an investigation may be made and information may be obtained through interviews with personal
references and past employers, through a credit check, a criminal history check and/or a driver’s record check. This inquiry
may include information as to, among other things, my character, general reputation and personal characteristics, as well
as information about my work performance and workplace conduct. I consent to this investigation and to the consideration
of any statements of references, former employers or others that are given in response to the inquiry. If Love & Learn
Preschool decides to obtain a consumer credit report, I understand that Love & Learn Preschool will provide, at my request,
the name and address of the reporting agency so I may obtain from such reporting agency the nature and substance of
information contained in such report.

I hereby release all parties, including but not limited to Love & Learn Preschool personal references and previous employers,
from liability for any injury or damage that may result from their furnishing information concerning me or any action Love &
Learn Preschool takes on the basis of such information.

I understand that, if I am offered a job, as a condition of beginning my employment, I may be required to undergo a physical
examination and drug screen, and I hereby authorize any doctor, hospital, clinic, laboratory and/or other medical facility to
furnish any medical information with reference to me as may be necessary in conjunction with that examination and related
considerations.

I understand that, according to federal law, all individuals who are hired must, as a condition of employment, produce certain
documentation to verify their identity and United States citizen status or, if aliens, their legal authorization to work in the
United States. As a consequence, I understand that any offer of employment to me is contingent upon my ability to produce
the required documentation within the time period required by law.

I understand that this application is not, and is not intended to be, a contract of employment and that any resulting
employment is for no fixed period of time and is terminable at any time and for any reason by me or by Love & Learn
Preschool. I further understand that statements which may be contained in policies, practices, handbooks or other material
do not create any guarantee of employment and that Love & Learn Preschool has the right to modify, amend or terminate
policies, practices, benefits plans or other programs within the limits and requirements imposed by law. I understand that
no representative of Love & Learn Preschool other than an officer, has the authority to enter into any agreement for any
specific period of time or to make any agreement contrary to the foregoing and that any such agreement must be in writing
to be binding.

I understand that, upon employment, I will sign an agreement relating to confidential information, if required.

I certify that I am not bound by any employment contract or non-competition agreement that would be breached by any
employment that might be offered to me by the Company, nor am I in possession of nor will I at any time reveal to the
Company, under any circumstances, any proprietary or confidential information that is the subject of any contract, nondisclosure agreement or prior work relationship involving any other person or entity.

Signature (type your name)

Date