Little Bear / University Preschool
Employment Application
You may fill out the form below and then print it with all the information you provided
or you may print the blank form and fill it out by hand.
Sign it and return it to one of the schools
Last Name:
First Name:
Middle Initial:
Present Address:
City:
State:
AL
AK
AZ
AK
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MO
MS
MT
NC
ND
NE
NV
NH
NJ
NM
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WI
WV
WY
Permanent Address:
City:
State:
AL
AK
AZ
AK
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MO
MS
MT
NC
ND
NE
NV
NH
NJ
NM
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WI
WV
WY
Phone:
Employment Desired
Position:
Date you can start:
Salary Desired: $
per month.
Are you employed?
Yes
No
If so, may we inquire of your present employer?
Yes
No
Have you ever applied ot this company before?
Yes
No
Where?
When?
Education History
Name and Location of School
Years attended
(ie:'67-'69
)
Did you graduate?
Subjects Studied
Grammer School
Yes
No
High School
Yes
No
College
Yes
No
Trade,Business or Corresponence School
Yes
No
General Information
Subjects of Special Study/Research Work or special skills:
U.S. Military or Naval Service:
Rank:
Former Employers
(List below your last four employers, starting with the last one First)
Date
Month and Year
Name and Address
Of Employer
Salary
Position
Reason for Leaving
From:
To:
$
Per
Week
Month
From:
To:
$
Per
Week
Month
From:
To:
$
Per
Week
Month
From:
To:
$
Per
Week
Month
References
(List below the names of three people not related to you , whom you have known at least one year)
Name
Address
Business
Years Known
Authorization
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."
Date:______________________ Signature:____________________________________________________
Interviewed by:_____________________________________________ Date:___________________________
