Right Start Academy

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION                                      Today's Date  

Last Name           First Name   

Address           

City                   State    Zip 

Home Phone        Cell/Other Phone   

Email Address  

Are you under 18 years of age?  Yes   No      

Are you a US citizen or legally eligible to work in the US?  Yes   No

JOB INTERESTS

Position Applying For    Full-Time   Part-Time

Desired Wage    Hourly     Yearly

Have you ever been convicted of a crime?  Yes   No

If yes, please explain below. An answer of yes may not disqualify you from employment.

EDUCATION

                       Name & Location     Years Attended      Course of Study      GPA    Degree Received

High School             
                  
College                   

Graduate                

Other                      

WORK EXPERIENCE (Present employer first)

Employer #1  Dates of Employment  TO

Address   City   State   Zip

Telephone   Supervisor's Name  

May we contact this employer for a reference?  Yes   No

Job Title   Rate of Pay   Hourly     Yearly

Reason for Leaving 

Job Duties: Please explain in detail below.

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Employer #2  Dates of Employment  TO

Address   City   State  Zip

Telephone   Supervisor's Name  

May we contact this employer for a reference?  Yes   No

Job Title   Rate of Pay   Hourly     Yearly

Reason for Leaving 

Job Duties: Please explain in detail below.

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Employer #3  Dates of Employment  TO

Address   City   State  Zip

Telephone   Supervisor's Name  

May we contact this employer for a reference?  Yes   No

Job Title   Rate of Pay   Hourly     Yearly

Reason for Leaving 

Job Duties: Please explain in detail below.

Right Start Academy does not discriminate on the basis of race, age, religion, national origin, marital status, disability, sex, sexual preference, status with regard to public assistance, or any other basis protected by law.

UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST.  AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.

I certify that all information provided in this application material is true. I understand that any false statement made herein is sufficient reason for rejection of this application or termination of subsequent employment regardless of date of discovery.

Applicant Name    Date