Columbus Day News

Impact Learning Centers EMPLOYMENT APPLICATION Personal Information Date Name Last First Middle Current Address Street Address Apartment/Unit # City State ZIP Permanent Address Street Address Apartment/Unit # City State ZIP Phone Email Date Available Desired Salary 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 yes, when? Are you at least 18 years of age? YES NO Education High School Name and Location of School Years Attended Did you graduate? YES NO Degree College Name and Location of School Years Attended Did you graduate? YES NO Degree Other Name and Location of School Years Attended 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 May we contact your previous supervisor for a reference? YES NO Company Phone Address Supervisor Job Title Starting Salary Ending Salary Responsibilities From To May we contact your previous supervisor for a reference? YES NO Company Phone Address Supervisor Job Title Starting Salary Ending Salary Responsibilities From To May we contact your previous supervisor for a reference? YES NO Military Experience Branch From To Rank at Discharge Type of Discharge If other than honorable, explain Skills Computer skills, equipment, other relevant experiences Applicant Signature Date Please read carefully, initial each paragraph, and sign below. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Impact Learning Centers to employ me. I understand that in connection with my application for employment and if I am hired, my continuing employment, Impact Learning Centers may request/receive information about my background, driving record, qualifications and qualifications. I authorize Impact Learning Centers to request/receive any and all information for those purposes. I certify that I have read and understand all of the questions set forth in this application and that the answers I have given are true and complete to the best of my knowledge. I understand that if I am employed, any false statements on this application may be cause for my dismissal. I understand that if I am hired, I will be an at-will employee. This means that I am free to resign at any time, for any reason or no reason; Impact Learning Centers is likewise free to conclude my employment at any time, with or without cause or notice, except as required by law. I understand that no one other than the owner of Impact Learning Centers can enter into any agreement guaranteeing employment for any specified period of time or making any representation or promise inconsistent with Impact Learning Centers’ at-will employment policy; any such agreement must be in writing and signed by the owner of Impact Learning Centers. Signature of Applicant Date