Employment
Application:
Full Name:
* Last:
* First:
Middle:
Address:
City:
State: Zip:
Phone:
Mobile Phone:
* Email:
Date available to start:
Salary Requirements:
If you are under 18 and we require
a work permit, can you furnish one? Yes No
If Yes, when?
If No explain:
Are you a citizen of the US?
Yes
No If not do you have
work papers? Yes
No
Type of employment desired:
Full-time
Part time
Temporary
Flex time
Have you ever pled "guilty" or "no
contest" to or been convicted of a crime?
Yes
No
If "Yes" give dates and details:
Answering Yes to
these questions does not constitute an automatic rejection to employment. Date
of the offense, seriousness and nature of the violation, rehabilitation and
position applied for will be considered.
Driver's license number if
applicable to the position:
Education:
High School:
Address:
# of years completed:
Did you graduate?
Yes
No Degree: GPA:
College/University:
Address:
# of years completed:
Did you graduate?
Yes
No Degree: GPA:
Additional Education:
References:
Please furnish the
names, address and phone numbers of two people to whom you are not related and
by whom you have not been employed :
Name:
Phone:
Address:
City:
State:
Zip:
Name:
Phone:
Address:
City:
State:
Zip:
Summarize your special skills or
qualifications:
Previous Employment: (begin with
most recent positions)
I certify that my
answers are true and complete to the best of my knowledge. I authorize Bartelt
Education Center to make such investigations and inquiries of my personal,
employment, educational, Financial, or medical history and other related
matters as may be necessary for an employment decision. I hereby release
employers, schools or persons from all liability in the event I am employed, I
understand that false or misleading information given in my application or
interview(s) may result in my discharge. *Check this box to indicate you certify your answers: