Realife STEAM Academy Employment Application

First Name*

Last Name*

Middle Initial*

Maiden Name

Date of Birth*

Date

Social Security #*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

High School Name *

Highest grade completed*

College

Major

Degree or years completed

Credit hours completed

Early Childhood Courses Completed/Workshops/Seminars

Infant & Child CPR Certificate*

NoYes

General Experience Related to This Job (teacher, volunteer, nanny, etc)*

Positions: Check all areas of interest*

#1 Full Name*

Company*

Address*

Phone*

Relationship*

#2 Full Name*

Company*

Address*

Phone*

Relationship*

#3 Full Name*

Company*

Address*

Phone*

Relationship*

Company #1*

Supervisor*

Phone*

Address*

Job Title*

Reason for leaving*

Starting Salary*

Ending Salary*

Start date*

Date

End date*

Date

May we contact your employer

YesNo (please explain why in box below)Other

Company #2*

Supervisor*

Phone*

Address*

Job Title*

Reason for leaving*

Starting Salary*

Ending Salary*

Start date*

Date

End date*

Date

May we contact your employer*

YesNo (please explain why in box below)Other

Name of Church

Pastor's Name

How long have you been attending this church?

Do you volunteer at church?

I hereby certify that the facts set forth in the above employment are true and complete to the best of my knowledge and authorize the administration of Realife STEAM Academy childcare ministries to verify their accuracy and to obtain reference information on my work performance. I understand that Realife STEAM Academy adheres to all rules by the state of Indiana which is contingent upon the completion of state-mandated guidelines. I hereby release Realife STEAM Academy from any/all liability of whatever kind and nature that, at any time could result from obtaining and having an employment decision based on such information.

I understand that if employed, falsified statements of any kind or omission of facts called for on this application shall be considered sufficient basis for dismissal. I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules, and regulations of employment of the employer. However, I further understand that neither the policies, rules, regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of an implied employment contract.I understand that any employment offered is for an indefinite duration and at will and that either the employer or I may terminate my employment at any time or without notice or

If this application leads to employment, I understand that false or misleading informationin

my application or interview may result in my release.

Signature*

Clear

Date*

Date

Realife STEAM Academy

Education:

References:

Previous Employment:

Church Information:

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