Clara Mohammed School, Inc. General Application

Please complete the following document to be considered for the open position.

Position applied for:

Type of work applied for:

Full Time Work

Part Time Work

Temporary Work

Phone Number

Desired start date:

Personal Information

Have you ever applied here before?

Yes Yes No

How did you find out about us?

Yes Yes No

Why are you applying to work at our company/organization?

Can you present evidence of your citizenship or proof of your legal right to live and work in this country?

Yes

Have you ever been convicted of a criminal offense, felony or serious misdemeanor?

Yes Yes No

Are you currently employed?

Yes Yes No

Education

High School

Name

Concentration

Did you graduate from High School?

Yes

College/University

Name

Major

Did you graduate from college/university?

Yes

Please describe any additional form of education you have completed:

Employment History

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Employer 1

Company Name

Phone Number

You position:

Supervisor name:

Employer 1 Dates of Employment

Start date:

End date:

Please describe your role and responsibilties:

Reason for leaving:

May we contact Employer 1?

Yes No

Employment History

Employer 2

Company Name

Phone Number

Your position:

Supervisor name:

Employer 2 Dates of Employment

Start date:

End date:

Please describe your role and responsibilities:

Reason for leaving:

May we contact Employer 2?

Yes No

Employment History

Employer 3

Company Name

Phone Number

Your position:

Supervisor name:

Employer 3 Dates of Employment

Start date:

End date:

Please describe your role and responsibilities:

Reason for leaving:

May we contact Employer 3?

Yes

References

Reference 1

Full Name

Phone Number

Reference 1 Occupation

How long have you known Reference 1?

Reference 2

Full Name

Phone Number

Reference 2 Occupation

How long have you known Reference 2?

Reference 3

Full Name

Phone Number

Reference 3 Occupation

How long have you known Reference 3?

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company's designated representative.

Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by the Company, I am entitled to copies of any such public records obtained by the Company unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below.

Applicant signs here:

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.