Clone of Adult Employment Application Form

STS Academy

710 Black Diamond Street, Pittsburg, CA 94565 * (925) 252-9199
Job Application
STS Academy is an equal opportunity employer dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religion, marial status, sexual orientation, political belief, or disability.

Federal law prohibits the employment of unauthorized aliens. All persons hired must submit to satisfactory proof of employment authorization and identity within three (3) days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.

___________________________________________
Personal Background
Name

First Name Last Name
Middle Initial
Social Security Number
Present Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Permanent Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Telephone Number
Referred By:
Position Applying For:
Date You Can Start:

*Note: Verification and completion of the I-9 form must be submitted no later than three business days after the date of hire.
Have you ever been convicted of a felony?

Yes No
(A conviction record will not necessarily be a bar for employment); if so, please describe fully the felony conviction(s), listing the natureof the offense, your age at the time of the offense, and your rehabilitation since the conviction(s).
Specialized technical skills (i.e. computer, software programs, foreign language(s), and any other tools or machines used:
Physical Record
If "Yes", What can we do to accommodate you?
Do you have any handicap or disability which would substantially interfere with your ability to perform the essential duties of the job for which you applied?

Yes No

Work Experience

List below last four employers, starting with your present or last place of employment
Employer 1

Date (Month/Year)
From:
To:
Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Salary
Position
Name of Supervisor
Reason for Leaving
Employer 2

Date (Month/Year)
From:
To:
Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Salary
Position
Name of Supervisor
Reason for Leaving
Employer 3

Date (Month/Year)
From:
To:
Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Salary
Position
Name of Supervisor
Reason for Leaving
Employer 4

Date (Month/Year)
From:
To:
Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Salary
Position
Name of Supervisor
Reason for Leaving

References

Give the name of three persons not related to you, whom you have known for at least 10 years
Reference 1
Name and Occupation

Name Occupation
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Years Known
Reference 2
Name and Occupation

Name Occupation
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Years Known
Reference 3
Name and Occupation

Name Occupation
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Years Known
Initials *

Release and Applicant's Signature
In connection with my application for employment and as a condition of continuing employment, I understand that investigative background checks may be made on me, including previous employers, schools, consumer credit, criminal convictions, motor vehicle, and other reports. These reports will include information as to my character, work habits, performance, education, compensation, and experience along with reasons for termination of employment from previous employers. Furthermore, I understand that the company may be requesting information from various federal, state, and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil, and other experiences as well as claims involving me in the files of insurance companies. I authorize without reservation, any party or agency contacted to furnish the above mentioned information and release all parties involved from liability and responsibility for doing so. I hereby consent to obtaining the above information from previous employers and/or any of their agents. This authorization and consent shall be valid in original, fax, or copy form.

All hiring and employment at STS Academy is at will. I understand this application is not an employment contract nor can it be used to create one. Employment by STS Academy has no specific term and may be terminated by the employee or STS Academy with or without notice. I acknowledge that STS Academy has not made any promises or representations that differ from those contained in this paragraph.
I understand I must provide satisfactory documents to establish my identity and right to work in the United States if I am offered a position with STS Academy and that failure to provide this evidence will result in termination of my employment.
I release and agree to hold harmless any individual company, business institution or government agency from all liability with regard to furnishing information to STS Academy. I agree to release and hold harmless STS Academy from all liability with respect to the receipt of such information.

I Certify that the the information that the information I have furnished on this application form is true and complete. I understand that if any misinterpretation has been made by me verbally or in writing, any offer of employment to me may be withdrawn or my subsequent employment with STS Academy may be terminated.
Date

Month Day Year
Date
Signature

Clear

PERSONAL INFORMATION & EMERGENCY CONTACT FORM
Employee Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Email
example@example.com
Emergency Contact 1
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Daytime Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Place of Employment
Emergency Contact 2
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Daytime Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Place of Employment
Medical Information
Medical Provider of Employee
Medical Record Number
Medical Facility Phone Number
Please enter a valid phone number.
Physician Name

First Name Last Name
Should be Empty:

STS Academy

Job Application

Personal Background

Educational Background

High School

College

Trade, Business, or Graduate School

Work Experience

Employer 1

Employer 2

Employer 3

Employer 4

References

Reference 1

Reference 2

Reference 3

Release and Applicant's Signature

PERSONAL INFORMATION & EMERGENCY CONTACT FORM

Emergency Contact 1

Emergency Contact 2

Medical Information