EvaLasting Touch Learning Center
Employment Application
Applicant Information
Full Name: ___________________________ Date: _______________ Address: _________________________________________________ City, State, ZIP Code: ______________________________________ Phone Number: ___________________ Email Address: ___________ Position Applied For: ________________________________________ Date Available: _____________________________________________ Desired Salary: _____________________________________________ How Did You Hear About Us? __________________________________ Are You a U.S. Citizen? [ ] 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? _______________________________________________ Have You Ever Been Convicted of a Felony? [ ] Yes [ ] No
If Yes, Explain: ________________________________________________ Education
High School: _______________________________________________ Address: _________________________________________________ From: __________ To: __________
Did You Graduate? [ ] Yes [ ] No
Degree: ________________________________________________
College: _______________________________________________
Address: _________________________________________________
From: __________ To: __________
Did You Graduate? [ ] Yes [ ] No
Degree: ________________________________________________
Other Education: ____________________________________________ Address: _________________________________________________ From: __________ To: __________
Did You Graduate? [ ] Yes [ ] No
Degree: ________________________________________________ References
Please List Three Professional References:
1. Full Name: ________________________________________________ Relationship: ______________________________________________ Company: _________________________________________________ Phone: ______________________________________________ Address: _________________________________________________
2. Full Name: ________________________________________________ Relationship: ______________________________________________ Company: _________________________________________________ Phone: ______________________________________________ Address: _________________________________________________
3. Full Name: ________________________________________________ Relationship: ______________________________________________
Company: _________________________________________________ Phone: ______________________________________________ Address: _________________________________________________ Previous Employment
1. 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
2. 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
3. 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: __________
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature: ________________________ Date: ________________