Employment Application Form

SCHOOL OF SUCCESS ACADEMY 6974 Wilson Blvd, Jacksonville, Florida 32210 phone (904) 573-0880 Fax (904) 573-0889

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APPLICATION FOR EMPLOYMENT

Please Print Clearly and Answer All Questions. Resumes are not a substitute for a completed Application.

TO APPLICANT: We appreciate your interest in School of Success Academy. A clear and full understanding of your background and work history will aid in the consideration for the position for which you are apptying. Applicants will be considered without discrimination because of race, color, sex. age, religion, national origin, marital status, disablllty, veteran's status, or other legally protected status. Criminal background checking will be addressed at a later stage in the candidate process in keeping with and to the extent allowed by applicable law.

Name:*

First NameLast Name

Phone Number:*

Area CodePhone Number

Present Address:*

(Street , Apt. or Unit Number)

Street Address Line 2

CityState / Province

Postal / Zip Code

Birth Date*

MonthDayYear

SSN#*

E-mail Address:*

Position Applying For:

Have you worked for or applied for a position with our Company before?

YesNo

If yes, when and what position?:

Do you have any relatives working here?

YesNo

If yes, who?:

(information is utilized for reporting structure purposes only)

Are you legally eligible for employment in the United States?

YesNo

Desired Salary

(Annual salary)

Are you 18 years of age or older?

YesNo

If no, please state your age

Are you seeking Full or Part-time work?

Full timePart-time

When are you available to begin work?

(mm/dd/yyyy)

List computer, foreign language and/or other work experience/skills which you feel qualifies you for the job for which you are applying:

Educational History*

LIST BELOW ALL PRESENT AND PAST EMPLOYMENT BEGINNING WITH MOST RECENT

Most Recent:*

Other Previous Employment 1

Other Previous Employment 2

List three people other than relatives who are in the position to evaluate your current or previous employment experience.
Preferably former supervisors or people with whom you have worked.

References*

Job Skills & Training

Describe your skills:*

Training or Certifications:

Certificates/Supporting Documents:

Upload a File

Upload Resume:*

Upload a File

I certify that all the information on this application, my resume, or any supporting documentation is correct, and I understand that any misrepresentation or omission of any information will result in disqualification from consideration for employment or, if employed, my termination.

I understand that this application is not a contract, offer or promise of employment. If hired, I will be able to resign at any time for any reason. Likewise, the Company can terminate my employment at any time, with or without any reason.

I authorize the Company or its agents to investigate all statements contained in this application and/or resume. Criminal background checking will be addressed at a later stage in the candidate process in keeping with and to the extent allowed by applicable law. A credit and background check may be made including, but not limited to, consumer credit history, criminal history, driving record, employment, military, education and general public records which will provide information concerning my character and general reputation. I hereby authorize my former employers, educational institutions or other reference providers to furnish all information pertaining to my work or educational record. I release my former employers, educational instltutions, supervisors, and references from all liability due to furnishing information to this company or its agents.

Should I wish to obtain a copy of the consumer credit history report (if applicable), it will be provided upon written request. I hereby release from liabillty the Company and its representative for seeking such information and all other persons, corporations or organizations for furnishing such information.

I understand that, as a condition of employment, I may be required to sign a non-compete agreement, a conflict of interest statement, and/or an arbitration agreement. Except where prohibited under statutory law, I hereby agree to arbitrate all disputes regarding my application for employment and any employment-ralated matters rather than resolving them in court or other forum. I understand that the Company may now have, or may establish, a drug-free workplace or a post-accident drug-testing program. If it has one now and I am offered a conditional offer of employment, I agree to work under the conditions requiring a drug-free workplace. I also understand that all employees of the location may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or controlled drugs. If detected, the offer of employment will be withdrawn. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo random, fitness for duty, return to work and/or reasonable suspicion alcohol and drug testing. Refusal to take such tests when asked may result in termination.

This application is current for only sixty (60) days. At. the conclusion of this time, if you have not heard from the Company and still wish to be considered for employment It will be necessary for you to complete a new application.

Applicant Signature*

Date*

Date