KTC Job Application Form

Any applicant considered for employment by Knox County Career Center must pass a BCI/FBI background check and a drug test at Mid-Ohio Corporate Care.

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, disability, marital or veteran status, or any other legally protected status.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

Date:*

Date

Position Applying For:*

Full Name*

First NameMiddle NameLast Name

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address*

example@example.com

Phone Number*

Have you ever been employed with us before?*

YESNO

If "YES", please give dates below:

Do any friends or relatives, other than a spouse work here?*

YESNO

If "YES", please state name and relationship:

*

	YES	NO
Are you currently employed?
Are you legally authorized to work in the U.S? (Proof of citizenship or immigration status will be required upon employment)
Have you ever been convicted of a crime?
Have you had any legal charges made against you that would prevent you from working in a public school with minors?
Can you perform the essential functions of this position with or without reasonable accommodations?

EDUCATION

	Name, City, State of School	Course of Study	Years Completed	Diploma / Degree
High School
Undergraduate College
Graduate/Professional
Other (Specify)

WORK EXPERIENCE: Start with your present or last job. Include any job-related military service, assignments, and volunteer activities. You may exclude organizations that indicate race, color, religion, gender, national origin, disabilities or other protected status.

EMPLOYER NAME 1

EMPLOYER 1

	Type Answer Below
Address
Telephone Number
Job Title Held
Supervisor
Dates Employed
Reason for Leaving

EMPLOYER NAME 2

EMPLOYER 2

	Type Answer Below
Address
Telephone Number
Job Title Held
Supervisor
Dates Employed
Reason for Leaving

EMPLOYER NAME 3

EMPLOYER 3

	Type Answer Below
Address
Telephone Number
Job Title Held
Supervisor
Dates Employed
Reason for Leaving

If you have gaps in employment, you may use this space to explain:

Describe any specialized training, apprenticeship, skills, and extra-curricular activities:

List professional, trade, business, or civic activities.

You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability, or other proteced status.

Technology - List computer knowledge and experience

PERSONAL/PROFESSIONAL REFERENCES (Do not include family members)

	Name	Phone Number	Email	Occupation
Reference 1
Reference 2
Reference 3

APPLICANT'S STATEMENT

I certify that the answers given herein are true and complete. I authorize the investigation of all statements contained in this application. I understand that false or misleading information given in my application or interview(s) will result in termination. I also understand that I am required to abide by all rules and regulations of the employer.

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APPLICATION FOR EMPLOYMENT