Career Opportunities – Linden Grove School

First Name
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Middle Initial

Last Name
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Address
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Address Line 2

City
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State
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Zip Code
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Home Phone (xxx-xxx-xxxx)
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Mobile Phone (xxx-xxx-xxxx)

Email
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Date Available
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Desired Salary
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Position Applied For
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Employment Desired
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Full-time

Part-time

Full- or Part- time

Have you ever worked for this company?
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Yes

No

If you've worked for this company before, when?

Have you ever been convicted of a felony or serious crime?
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Yes

No

If you have been convicted of a felony or serious crime, please explain.

Referred by:

Education

High School Attended and Address
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High School Started
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High School Ended
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Did you graduate high school?
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Yes

No

What was your high school degree, if any?

College Attended and Address

College Started

College Ended

Did you graduate college?

Yes

No

What was your college degree, if any?

Other Education and Address

Other Education Started

Other Education Ended

Did you graduate the other education?

Yes

No

What was your other education degree, if any?

Special Skills / Training?

References

Professional Reference #1
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Relationship/Title
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Company
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Phone (xxx-xxx-xxxx)

Company Address
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Professional Reference #2
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Relationship/Title
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Company
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Phone (xxx-xxx-xxxx)
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Company Address
*

Professional Reference #3
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Relationship/Title
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Company
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Phone (xxx-xxx-xxxx)
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Company Address
*

Previous Employment (most recent first)

Company #1
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Phone (xxx-xxx-xxxx)
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Company Address
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Supervisor
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Job Title
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Starting Salary
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Ending Salary
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Duties Performed
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Employed at Company From
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Employed at Company To
*

Reason for Leaving
*

May we contact your previous supervisor for a reference?
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Yes

No

Company #2

Phone (xxx-xxx-xxxx)

Company Address

Supervisor

Job Title

Starting Salary

Ending Salary

Duties Performed

Employed at Company From

Employed at Company To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

Company #3

Company Address

Supervisor

Job Title

Starting Salary

Ending Salary

Duties Performed

Employed at Company From

Employed at Company To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

Disclaimer and Signature

All information provided by me in support of my application for employment is true and correct to the best of my knowledge. I understand that misrepresentations or omissions may be cause for rejection, or may be cause for subsequent dismissal if I am hired. I agree to abide by all established rules and policies of the company as a condition of continued employment. I also agree to repay the company for any money advanced or for any things of value furnished by the company through payroll deductions for monies due to the employee. I further agree to allow former employers and referenced to release any information that is lawful to release.
*

I understand

Signature

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