Employment Application Step 1 of 2 50% An Equal Opportunity Employer-All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. The Adult Education Center will make reasonable workplace accommodation for any applicant or employee with a disability that does not constitute an undue hardship. Reasonable Accomodation requests must be referred to the Hiring Manager or Supervisor.Incomplete information could disqualify you from further consideration. Please complete all fields.APPLICANT INFORMATIONName First Last M.I. Date MM slash DD slash YYYY Street Address Apartment/ Unit # City State Zip Home PhoneMobile Phone #Email Are you eligible to work in the U.S.? YES NO Are you at least 18 years or older? (If no, you may be required to provide authorization to work.) YES NO Have you ever been terminated from employment or asked to resign by an employer? YES NO If yes, Please provide company names and detailsCan you work any shift? YES NO Can you work overtime, including weekends? YES NO Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation? YES NO EMPLOYMENT DESIREDDate you can start MM slash DD slash YYYY Hourly Rate/ Salary desired Position desired Are you currently employed? If so, may we inquire of your present employer? REFERRAL SOURCEHow did you hear about us? Walk In Advertisement Referral Others Have you ever worked for this company before? YES NO If yes, please explain. Do you know anyone who works for our company? YES NO If yes, who? EDUCATIONHigh School Address Number of years attended Did you graduate? YES NO Subjects Studied College or University Address Number of years attended Did you graduate? YES NO Degree Received and Major Trade, Business or Correspondence School Address Number of years attended Did you graduate? YES NO Degree Received and Major EMPLOYMENT HISTORYINCLUDE YOUR LAST SEVEN (7) YEARS OF EMPLOYMENT HISTORY, INCLUDING PERIODS OF UNEMPLOYMENT, STARTING WITH THE MOST RECENT AND WORKING BACKWARDS IN TIME.Employer Name Telephone Address Supervisor/Title Job Title and Responsibilities From To Reason for Leaving Employer Name Telephone Address Supervisor/Title Job Title and Responsibilities From To Reason for Leaving Employee Name: Telephone Address Address Supervisor/Title Job Title and Responsibilities From To Reason for Leaving REFERENCESGive the names of three persons not related to you, whom you have known at least three (3) yearsFull Name Company Address, Phone, E-mailYears Acquainted Full Name Company Address, Phone, E-mailYears Acquainted Full Name Company Address, Phone, E-mailYears Acquainted DISCLAIMER AND SIGNATUREThe Adult Education Center is an equal opportunity employer. The Adult Education Center does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, gender, sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for The Adult Education Center to hire me. If I am hired, I understand that either The Adult Education Center or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of The Adult Education Center has the authority to make any assurance to the contrary. I attest with my signature below that I have given to The Adult Education Center true and complete information on this application. No requested information has been concealed. I authorize The Adult Education Center to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information. I understand that this will constitute cause for the denial of employment or immediate dismissal.SignatureDate MM slash DD slash YYYY THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE SIGNED/DATED ABOVE.