Position Sought:
Lead Teacher
Assistant Teacher
Aid to Teacher
Director (Full Time)
Director (Part Time)
First Name:
Middle Name:
Last Name:
Preferred Name:
Current Address
Street Address:
City:
State:
Zip:
If you have resided at your present address less than 3 years,
list your prior address:
Street Address:
City:
State:
Zip:
Best Phone #:
The above number is for a cell phone.
Home Phone #:
Work Phone #:
Other Phone #:
Email Address:
Have you ever been arrested, charged, convicted of or pled
guilty to a crime?
Yes
No
(Conviction or plea will not necessarily disqualify applicant from employment)
If yes, please state when, where and final outcome:
Family Flex’s operating hours include daytime, evening (until 11pm) and
weekend hours. Please check your schedule availability.
I am available and desire to work FULL-TIME (40 hours) and do not have restrictions
on my hours and days. (Complete Section B.)
I am available and desire to work PART-TIME (If less than 40 hours a week, complete
Sections A & B).
A. I am only available for PART-TIME because:
Student
Other Job
Other:
B. Hours Available
NOTE: WORK SCHEDULES ARE BASED UPON THE NEEDS OF THE BUSINESS
AND MAY BE SUBJECT TO CHANGE ON A WEEKLY BASIS.
Salary/Wage Expected:
Date Available for Work:
HighSchool
Name and City of School
Major Subject
Last Year Graduated
Did you Graduate?
Degree
College
Name and City of School
Major Subject
Last Year Graduated
Did you Graduate?
Degree
Second College
Name and City of School
Major Subject
Last Year Graduated
Did you Graduate?
Degree
Graduate School
Name and City of School
Major Subject
Last Year Graduated
Did you Graduate?
Degree
Business Trade Other
Name and City of School
Major Subject
Last Year Graduated
Did you Graduate?
Degree
List the name, telephone number, and email address of three
(3) references that are not related to you and are not previous employers.
First Reference
Name:
Phone:
Email:
Second Reference
Name:
Phone:
Email:
Third Reference
Name:
Phone:
Email:
Starting with your present or most recent job, list your employment
experience. You may include job-related military service assignments and volunteer activities
that reflect your qualifications for employment. Do not omit any employment.
First Employer
Employer
Address
Phone:
Immediate Supervisor
Job Title
Employment Dates
Start Date :
End Date :
Salary/Hourly Rate
Starting:
Ending:
Kind of Work:
Ages of Children in your Charge:
Reason for Leaving:
Explain any Period Between Jobs:
Second Employer
Employer
Address
Phone:
Immediate Supervisor
Job Title
Employment Dates
Start Date :
End Date :
Salary/Hourly Rate
Starting:
Ending:
Kind of Work:
Ages of Children in your Charge:
Reason for Leaving:
Explain any Period Between Jobs:
Third Employer
Employer
Address
Phone:
Immediate Supervisor
Job Title
Employment Dates
Start Date :
End Date :
Salary/Hourly Rate
Starting:
Ending:
Kind of Work:
Ages of Children in your Charge:
Reason for Leaving:
Explain any Period Between Jobs:
May we contact the employers listed above?
Yes
No
If no, indicate which one(s) you do NOT wish us to contact,
and state the reason why.
Have you ever been discharged or asked to resign from any
position?
Yes
No
If yes, please state the employer and dates of employment.
(Please indicate that you have read and that you understand each paragraph of this
Applicant’s Statement by placing your initials beside each paragraph)
I certify that this application and my attached resume were completed by me and that
all entries on it and all information in them are TRUE and COMPLETE to the best of my
knowledge. In the event of employment, I understand that false, misleading or omitted
information in my application and resume may result in termination.
I authorize investigation of all statements contained in this application for employment
as may be necessary in arriving at an employment decision. In making this application
for employment, I understand that information may be obtained through interviews with
the personal references and past employers and from third party companies who specialize
in conducting background checks. This inquiry may include information as to my character,
general reputation, and personal characteristics, as well as information about my work
performance, workplace conduct and criminal record. I consent to this review and to the
consideration of any statements of references of former employers that are given in response
to the inquiry.
I hereby release all parties, including Family Flex, personal references, previous
employers and independent third parties, from liability for any injury or damage that
may result from their obtaining or furnishing information concerning me or any action
Family Flex takes on the basis of such information.
I understand that, according to federal law, all individuals who are hired must, as
a condition of employment, produce certain documentation to verify their identity and
United States citizen status or , if aliens (non U.S. citizens), their legal authorization
to work in the United States. As a consequence, I understand that any offer of employment
to me is contingent upon my ability to produce the required documentation within the
time period required by law.
I understand that this application is not, and is not intended to be, a contract of
employment and that any resulting employment relationship is for no fixed period of time
and is terminable at any time and for any reason by Family Flex, LLC or by me. I further
understand that statements which may be contained in policies, practices, handbooks or
other firm material do not create any guarantee of employment and that Family Flex has
the right to modify, amend, or terminate policies, practices, benefits plans, or other
programs within the limits and requirements imposed by law.
