Columbus Day News

LITTLE LEARNERS OF OKEECHOBEE 408 NW 4th Street Okeechobee, Florida 34972 772-597-2224 EMPLOYMENT APPLICATION PERSONAL INFORMATION Full Name: Date: Last First Middle Current Address: Street Address Apartment/Unit # City State ZIP Code Mailing Address: Street Address Apartment/Unit # City State ZIP Code Phone: Email Address: Date Available: Social Security Number: Position Applied for: Are you a citizen of the United States? YES NO If no, are you authorized to work in the U.S.? YES NO Have you ever worked for this company? YES NO If so, when? Have you ever been convicted of a felony? YES NO If yes, explain: EDUCATION High School: Address: From: To: Did you graduate? YES NO Diploma:: College: Address: From: To: Did you graduate? YES NO Degree: Other: Address: From: To: Did you graduate? YES NO Degree: REFERENCES Please list three professional references. Full Name: Relationship: Company: Phone: Address: Full Name: Relationship: Company: Phone: Address: Full Name: Relationship: Company: Phone: Address: PREVIOUS EMPLOYMENT Company: Phone: Address: Supervisor: Job Title: Starting Salary: $ Ending Salary: $ Responsibilities: From: To: Reason for Leaving: May we contact your previous supervisor for a reference? YES NO Company: Phone: Address: Supervisor: Job Title: Starting Salary: $ Ending Salary: $ Responsibilities: From: To: Reason for Leaving: May we contact your previous supervisor for a reference? YES NO Company: Phone: Address: Supervisor: Job Title: Starting Salary: $ Ending Salary: $ Responsibilities: From: To: Reason for Leaving: May we contact your previous supervisor for a reference? YES NO Military Service: Branch: From: To: Rank at Discharge: Type of Discharge: If other than honorable, explain: Additional skills & qualifications that may be helpful in employment at our program: BACKGROUND CHECK As a condition of employment, Little Learners of Okeechobee will conduct a background check on all prospective employees. This background will include a search of criminal records, abuse registry and driving records. Refusal to consent to a background check will disqualify you from employment. Do you consent to a background check? YES NO MISCELLANEOUS Do you have a valid Florida Driver’s License? YES NO If yes, license number: Do you have current auto insurance coverage? YES NO Do you have current CPR and First Aid Certification? YES NO Are you able to lift 35 pounds unassisted? YES NO ACKNOWLEDGEMENT AND AGREEMENT 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 application is valid for 90 days. After that, unless otherwise notified, I understand that my application will be purged from the system. Signature of Applicant: Date: Little Learners of Okeechobee is an Equal Opportunity Employer. We do not discriminate on the basis of race, religion, color, sex, age, national origin or disability.