Enrich and Grow Academy Employment Application

Personal Information

Name: (Last, First, MI)

Current Street Address Line 1:

Current Street Address Line 2: (Optional)

City: State: Zip Code:

Home Phone Number:	Cell Phone Number:
Primary Email Address:	Secondary Email Address: (Optional)

Social Security Number: **(required for employment)**

Driver’s license number/state/expiration:

Employment Desired

Position(s) Applied For?

How did you hear about this position?

Date Available for Work:	Pay Amount Applied For: eg. $10.00/hr	Today's Date: MM/DD/YY

Education

	Name and Address of School	Course of Study	Total Years of Study	Degree/Diploma
High School
Undergraduate College
Graduate/Professional
Other(specify)

List any seminars, classes or other education not listed above which may help qualify you for this position:

Employment History

List below all present and past employers over the past 10 years, starting with your most recent employer. Account for all periods of unemployment. You must complete this section even if attaching a resume. May we contact your current employer? Yes No

Employer 1:
Employer: (Current Employer? Yes No)	Start Date:	End Date:
Address:
City, State, Zip	Starting Salary	Ending Salary

Company Main Phone Number
Supervisor's Phone Number	Supervisor Email Address
Supervisor(s)	Job Position(s)
Reason for leaving:	Essential job functions of final position:

Employer 2:
Employer: (Current Employer? Yes No)	Start Date:	End Date:
Address:
City, State, Zip	Starting Salary	Ending Salary

Company Main Phone Number
Supervisor's Phone Number	Supervisor Email Address
Supervisor(s)	Job Position(s)
Reason for leaving:	Essential job functions of final position:

Employer 3:
Employer: (Current Employer? Yes No)	Start Date:	End Date:
Address:
City, State, Zip	Starting Salary	Ending Salary

Company Main Phone Number
Supervisor's Phone Number	Supervisor Email Address
Supervisor(s)	Job Position(s)
Reason for leaving:	Essential job functions of final position:

Employer 4:
Employer: (Current Employer? Yes No)	Start Date:	End Date:
Address:
City, State, Zip	Starting Salary	Ending Salary

Company Main Phone Number
Supervisor's Phone Number	Supervisor Email Address
Supervisor(s)	Job Position(s)
Reason for leaving:	Essential job functions of final position:

Employer 5:
Employer: (Current Employer? Yes No)	Start Date:	End Date:
Address:
City, State, Zip	Starting Salary	Ending Salary

Company Main Phone Number
Supervisor's Phone Number	Supervisor Email Address
Supervisor(s)	Job Position(s)
Reason for leaving:	Essential job functions of final position:

Employer 6:
Employer: (Current Employer? Yes No)	Start Date:	End Date:
Address:
City, State, Zip	Starting Salary	Ending Salary

Company Main Phone Number
Supervisor's Phone Number	Supervisor Email Address
Supervisor(s)	Job Position(s)
Reason for leaving:	Essential job functions of final position:

Additional Information

Can you provide proof of U.S. citizenship or proof of your legal right to work in the U.S.? Yes No

If hired, do you have your own reliable car to travel to work? Yes No

Have you ever been convicted of a felony or misdemeanor? Yes No

If Yes, please explain:

References

List below three people not related to you who have knowledge of your work performance within the last 5 years. Please do not list friends or family.

Reference 1

Name

Occupation

Company Name

Address

Telephone Number

Relationship and Years Acquainted eg. Professor, 4 years

Reference 2

Name

Occupation

Company Name

Address

Telephone Number

Relationship and Years Acquainted eg. Professor, 4 years

Reference 3

Name

Occupation

Company Name

Address

Telephone Number

Relationship and Years Acquainted eg. Professor, 4 years

List any professional, trade, business or civic activities and offices held:

Identify formal job training that relates to this position:

Identify what skills you possess related to this position:

If you are hired, what value would you add to our company:

Submit Application

Authorization and General Release Form:
I certify that the facts contained in this employment application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for immediate dismissal.

I understand that, if hired, my employment and compensation can be terminated with or without notice, with or without cause, at the option of Enrich and Grow Academy or myself.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal, or otherwise and release the information from all liability for any damage that may result from utilization of such information.

The undersigned in connection with this application, authorizes all corporations, companies, credit agencies (in applicable positions), educational institutions, persons, law enforcement agencies, military services and former employers to release information they may have about me to Enrich and Grow Academy or its agents and releases them from any liability or responsibility from doing so. Further, I authorize the procurement of an investigative consumer report (in applicable positions) and understand that such a report may contain information about my background, character and personal reputation. I understand that this notice will also apply to any future update reports that may be requested.

I hereby authorize Enrich and Grow Academy to thoroughly investigate my background, references, employment record and other matters related to my suitability for employment. I authorize persons, schools, my current employer (if applicable), and previous employers and organizations contacted by Enrich and Grow Academy to provide any relevant information regarding my current and/or previous employment and I release all persons, schools, employers of any and all claims for providing such information. I understand that misrepresentation or omission of facts may result in rejection of this application, or if hired, disciplined with up to and including dismissal. I understand that nothing contained in this application, or conveyed during any interview which may be granted, is intended to create an employment contract. I understand that filling out this form does not guarantee there is a position open and does not obligate Enrich and Grow Academy to hire me. I understand and agree that my employment is at will, which means that it is for no specified period and may be terminated by me or Enrich and Grow Academy at any time without prior notice for any reason.

I have read and agree to the disclaimer.