Back-2-Basics Learning Centers Employment Application
First Name                Middle Initial                       Last Name *
Home Address (City, State, Zip Code) *
Daytime/ Evening phone number *
Social Security Number (last 4 digits) verification upon job offer *
Driver's License (State/Number) *
Emergency Contact *
Job Position Applying for: *
Desired Salary *
Prior Job Experience *
Who referred you to our company? *
Are you at least 18 yrs. of age? *
Are you willing to work any shift, including weekends? *
Can you lift at least 40 lbs. without any medical restrictions? *
If you are offered employment, when would you be available to begin work? *
If hired, are you able to submit proof that you are legally eligible for employment in the United States? *
Check those skills that you have. List any other skills that may be useful as an Academic Tutor *
Required
Do you have any teaching experience? *
Dropdown
  1. Yes
  2. No
  3. Years of experience
Applicant Employment History: *
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Applicant Employment History: *
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Applicant Employment History: *
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Applicant Employment History: *
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Applicant's Education and Certification: *
College/University Name and City/State
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College University Name, City & State                              Did you receive a degree? *
High School Name, City & State                                                      Did you earn a HS diploma? *
Other Training (graduate, technical, vocational):
Please indicate any current professional licenses or certifications that you hold:
Professional References: List any two non-relatives who would be willing to provide a reference for you. *
Dropdown
  1. Name
  2. Address
  3. City/State/Zip
  4. Telephone
Professional References: List any two non-relatives who would be willing to provide a reference for you. *
Dropdown
  1. Name
  2. Address
  3. City/State/Zip
  4. Telephone
Please provide any other information that you believe should be considered, including whether you are bound by any agreements with any current employer:
CERTIFICATION: I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.I authorize Back-2-Basics Learning Centers to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its CEO, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Back-2-Basics Learning Centers, except in a specific written contract of employment signed on behalf of the organization by its CEO, has the power to alter or vary the voluntary nature of the employment relationship.I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.____________________________________ _______________ APPLICANT SIGNATURE DATE *
Applicant Signature/Date
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