Support Staff Application
Excelsior Academy
Elementary school | 124 E. Erda Way
Middle school | 162 E. Erda Way

Erda, Utah 84074
O 435.882.3062 | F 435.882.4997
First and last name *
Address *
Best phone number *
Email *
Position applying for *
Work history, volunteer experience, noteworthy skills
Three references (name, phone, email)
If you would like to send a resume or other documents, please email to:
Please answer the following questions:
Note: It is important that you give complete and truthful answers to the following questions. If you answer yes to any of the following questions, please provide an explanation at the bottom of the section. Include convictions from a plea of nolo condender (no contest), and information about any expungement.

We will consider the date, facts, and circumstances of each event you list. In many cases you can still be considered for employment with Excelsior Academy. However, if you fail to tell the truth or fail to list all relevant events and circumstances, this may be grounds for not hiring you, or grounds for dismissal after you begin employment.
1. During the last 10 years, have you been fired from any job for any reason, quit after being told you would be fired, or leave by mutual agreement because of a specific problem? *
2. Have you ever been arrested for, convicted of, or forfeited collateral for any felony or misdemeanor violation? *
3. Have you ever been arrested for, convicted of, or forfeited collateral for any firearm or explosives violation? *
4. Are you now under investigation for misconduct or any violation of law? *
5. Have you ever been convicted by a military court-martial? *
6. Have you been found pursuant to a criminal, civil, or administation action to have committed a sexual offense against a minor child, or had any sustained child abuse charges files against you? *
7. Have you voluntarily resigned or surrendered a professional license or certificate in the face of a charge relating to incidents in questions1-6 above? *
8. Are you now under investigation, on notice of warning, or under probation for any concern related to your employment, maintaining a license, or professional certificate? *
9. Does Excelsior Academy employ any relative(s) of yours, either by blood or marriage? *
Please list any YES explanations from questions 1-9. If not applicable, type N/A. *
By checking the box, I hereby verify that the information provided in this application and in the questions is true and correct to the best of my knowledge. Any misstatement, omission, or misinformation is grounds to not hire or for dismissal. *
I understand and agree that this application does not guarantee employment and is not a contract. I understand that if the school makes an employment offer, acceptance of employment is not a contract of employment for a specified term. This application does not create any expectation of employment or continued employment. I understand that the school employee/employer relationship is an at-will relationship and can be terminated by either party at any time, with or without cause, and with or without notice. I understand that the human resources department will make all formal offers of employee compensation and/or benefits. I understand that any handbooks, manuals, policies, and procedures maintained by the school are not contractual in nature, and therefore may be waived, suspended, ammended, or abolished at the sole discretion of the school at any time. Should I become an employee of the school, I will abide by the terms of the school's policies, which are subject to change or ammendment and will conduct myself in an ethical and legal manner. I will, in addition, obey all the laws of the United States, the State of Utah, and of all localities where the school operates.

I both understand and do authorize the school to perform a criminal background check on me and make such investigations and inquiries of my criminal, personal, social, and employment histories, and other related matters as may be necessary in arriving at an employment decision, or to qualify for and upon employment. I hearby release the school, former employers, and any other persons from any and all liability in regards to discussing and/or releasing information in connection with the school's due diligence efforts regarding my employment application and related paperwork. If I am offered and choose to accept employment with the school, I understand I will be required to demonstrate within three (3) days that I am legally permitted to work in the United States. Failure to provide evidence of employment eligibility verificationwill result in termination of employment.

I certify that the information furnished herein was completed by me and that all supporting documents and my resume (if included) are true and complete to the best of my knowledge. I understand that any omission or misrepresentation of material facts on any record or document submitted for employment will constitute grounds for denial of employment or immediate termination of employment regardless of the timing of discovery.

By checking the box and entering my name below, I agree I have read and understand the certifications. *
Full Name *
Today's Date *
Equal Employment Opportunity (EEO) Policy Statement
It is the policy of the school to promote equal employment opportunities. The school is an equal opportunity employer. The school will not discriminate, nor tolerate discrimination, against any applicant or employee because of race, color, sex, religion, national origin, disability, veteran status, age, marital status, or any other group protected by law.
Never submit passwords through Google Forms.
This form was created inside of Excelsior Academy. Report Abuse