Project Learn Job Application Form

Full Name*

First NameLast Name

E-mail*

example@example.com

Phone Number*

What position are you applying for?*

Available start date:*

Date

What is your current employment status?*

EmployedUnemployedSelf-EmployedStudent

Employment status you are seeking?

Full-timePart-timeTemporaryFlexible (either full or part time)

For part-time positions, what shift(s) are in you interested in?

MorningsAfternoonsEvenings

List any friends or relatives employed by the company. What is your relationship?*

Are you 18 years or older?*

YesNo

If not, do you have a work permit?*

YesNoN/a

Employment Experience 1. (List each job held. Start with your present or last job. Include military service and volunteer experience.)*

Employment Experience 2. (List each job held. Start with your present or last job. Include military service and volunteer experience.)*

Employment Experience 3. (List each job held. Start with your present or last job. Include military service and volunteer experience.)

Please explain gaps in employment greater than 90 days, including date(s) and reason(s).

Education: High School*

Education: College*

Education: Other (specify)*

Have you ever been convicted of a felony?*

YesNo

If yes, please provide all details. (*conviction of a crime will not automatically disqualify you from employment.)

Reference 1. Please list professional references only. Do not list friends or relatives.*

Reference 2. Please list professional references only. Do not list friends or relatives.*

Reference 3. Please list professional references only. Do not list friends or relatives.

Upload Resume and Cover Letter Here*

EQUAL OPPORTUNITY EMPLOYER

Qualified applicants are considered without regard to race, color, religion, gender, national origin, age, mental or physical disabilities, marital status, veteran status, sexual orientation, gender identity or expression, genetic information, or any other characteristic protected by applicable law. All employment decisions shall be consistent with the principles of equal opportunity employment. Accommodations to enable all individuals to participate in the application process may be provided upon advance request.

I represent that my responses set forth in this Application are truthful, accurate, and complete. Any and all false or inaccurate statements made by me in this Application or otherwise during the employment evaluation process shall be grounds for both rejecting my Application for employment and, should I be hired by Project LEARN, termination of my employment.

I authorize representatives of Project LEARN to contact educational institutions, state and federal agencies (to conduct driving record checks and criminal history record checks) and employers designated in this Application for purposes of verification and investigation of my educational, criminal record, driving record, and employment background and performance. Such individuals and organizations are authorized to release such information as may be requested by a Project LEARN representative. I hereby release all such persons from liability or damages incurred as a result of furnishing such information. I understand that an unsatisfactory reference shall be grounds both for rejecting my Application for employment and, should I be hired by Project LEARN, termination of my employment. Should I be employed by Project LEARN, I understand that I could be subject to an outside probe if accused of wrongdoing.

Please be aware that Project LEARN is required to report New Hire information to the State of Ohio, Department of Human Services, and other government entities monthly or within 21 days of the date of hire. Project LEARN complies with this legal requirement.

Project LEARN desires to maintain a safe and healthy working environment for the benefit of all employees. Where there is a reasonable question as to whether or not I can safely perform the duties of my job due to my physical or mental condition, Project LEARN shall have the right to require that I submit to physical or mental examinations for purposes of receiving medical confirmation that I can safely perform the duties of my job. Any and all such examinations shall be for job-related purposes only and shall be performed by a medical practitioner selected and paid for by Project LEARN. I hereby release all such information to Project LEARN and waive any right of confidentiality.

Submission of the Application does not entitle me to be interviewed by Project LEARN. Further, nothing in this Application or in the employment evaluation process shall be construed as either an offer of employment or an obligation on the part of Project LEARN to provide any benefit to me. This Application shall be pending, unless withdrawn by me, until company decides on whether or not to hire me or until the 90th day after submission of this Application to Project LEARN, whichever occurs first. If no action is taken on my Application within a 90-day period, I understand that I must re-apply to Project LEARN in order to be considered for employment. Should I be employed by Project LEARN, I agree to comply with any and all employment rules and policies of Project LEARN.

After reading all the terms of this Application, I hereby affirm that I understand and agree to the provisions of the same. I also agree that my employment with Project LEARN is on an “at-will” basis, meaning that such employment may be permanently discontinued by either Project LEARN (through discharge or layoff) or myself through voluntarily quitting at any time without notice and without any recourse of any kind by either party. I expressly agree and understand this is the entire agreement between Project LEARN and me on the subject of discharge, termination and/or layoff, and it may be changed only by an agreement in writing signed by the Executive Director. Any intentional deception or misrepresentation herein may be considered sufficient cause for dismissal.

If selected for employment, I am willing to submit to a background check.

Applicants Signature*

Employment Application