KICKSTART KIDS

KICKSTART KIDS

Employee Application
Our company is an equal opportunity employer and will consider all applicants for all positions equally without regard to their race, color, sex, age, religion, national origin, citizenship, genetic information, veteran status, disability or any other classification or characteristic protected by law. This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Each question must be answered in a complete and accurate manner as no action can be taken on this application until all questions have been answered. If a question is not-applicable, place "NA" for that question.
PERSONAL INFORMATION
Name
Date

MonthDayYear
Date
Home Phone
Format: (000) 000-0000.
Other Phone
Format: (000) 000-0000.
Fax
Email Address
example@example.com
ADDRESS INFORMATION
Current Address
City
State
Zip
Num. Years
Previous Address
City
State
Zip
Num. Years
1. Are You Over 21?
2. Please indicate if you are authorized to work in the United States.
3. Have you ever been convicted of any crime?
If yes, state the offense, location, date, and disposition on a separate sheet of paper. Note: A conviction will not necessarily disqualify you from employment.
4. Do you have the ability, with or without reasonable accommodations, to work overtime or to travel if travel and/or overtime are required by the job for which you are applying?
5. Would you be willing and able to relocate?
6. Which region are you interested in applying for? (You may select more than one option.)
7. Do you have a Driver’s License?
State
Drive License Number
Is it Valid?
EMPLOYMENT DESIRED
1. Are You Seeking:
2. Position applied for
Annual Salary Desired:
3. Date available to Start

MonthDayYear
Date
4. Have you ever APPLIED with our company?
5. Have you ever WORKED for our company?
If you answered “yes” to either question 4 or 5, state when and where you applied and/or worked?
6. Are you now, or expect to be, working in any other business or job?
7. Are there any days or hours would be unable or unwilling to work?
If yes, please specify the days or hours you would be unable or unwilling to work.
8. How did you hear about this job opening?
Job Search Site (which):
Other:
EDUCATION
High School:
Address:
Years Attended:
Major Courses:
Did You Graduate?
What Degree
College
Address
Years Attended:
Major Courses
Did You Graduate?
What Degree?:
Trade School:
Address:
Years Attended:
Major Courses:
Did You Graduate?
What Degree
Are you planning to pursue further studies?
If yes, when where and what courses
List any scholastic honors offices held and activities involved in during high school and college.
List and describe any other school or specialized training.
Military
1. Have you ever served in the military?
Service Branch
Date

MonthDayYear
Date
2. Type of Discharge
Date Separated

MonthDayYear
Date
Final Rank
CAPABILITY / RELIABILITY
1. Would you be willing and able to perform all of the tasks required by the job you are applying for?
If no, explain which tasks:
2. Will you abide by the safety rules of this company?
3. Have you ever been disciplined for violating company safety rules and/or regulations?
If yes, please explain:
4. How many days of work or school have you missed in the last two years?
5. How many times have you been late to work or school in the last two years?
6. Would you be willing and able to report to work on time every day on a regular and consistent basis?
7. Are you CPR/AED certified?
WORK HISTORY
List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references.

Please Give Month and Year
Name of Employer:
Address:
Telephone:
Format: (000) 000-0000.
Supervisor:
Job Title:
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Annual Salary:
Reason for Leaving:
Duties:
Name of Employer:
Address:
Telephone:
Format: (000) 000-0000.
Supervisor:
Job Title:
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Annual Salary:
Reason for Leaving:
Duties:
Name of Employer:
Address:
Telephone:
Format: (000) 000-0000.
Supervisor:
Job Title:
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Annual Salary:
Reason for Leaving:
Duties:
Name of Employer:
Address:
Telephone:
Format: (000) 000-0000.
Supervisor:
Job Title:
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Annual Salary:
Reason for Leaving:
Duties:
WORK HISTORY (Continued)
If you worked in any of your previous positions under another name, please provide that name below. (For references purposes only)
Name:
Company:
Name:
Company:
Are you currently employed?
If yes, may we contact your employer?
Have you ever been fired or asked to resign?
If yes, please explain:
Have you ever been disciplined or received verbal or written warnings for absenteeism or tardiness?
If yes, please explain:
MARTIAL ARTS BACKGROUND
List all martial arts styles you have studied and hold a ranking in.
Style:
Rank Held:
Phone Number:
Format: (000) 000-0000.
School Name:
Instructor/Instructors:
Style:
Rank Held:
Phone Number:
Format: (000) 000-0000.
School Name:
Instructor/Instructors:
Style:
Rank Held:
Phone Number:
Format: (000) 000-0000.
School Name:
Instructor/Instructors:
Have you ever taught a seminar?
If yes, please complete below:
Subject:
Number of students in attendance:
Location:
Subject
Number of students in attendance
Location
Do you or have you ever, owned a school/studio?
If yes, please complete below:
School Name
Date Opened:

MonthDayYear
Date
Date Closed:

MonthDayYear
Date
Address:
Phone Number:
Format: (000) 000-0000.
Reason for closing or selling:
Current Owner
Age Group of Students:
School Name
Date Opened

MonthDayYear
Date
Date Closed

MonthDayYear
Date
Address
Phone Number
Format: (000) 000-0000.
Reason for closing or selling
Current Owner
Age Group of Students:
Do you or have you ever taught or managed a school/studio?
If yes, please complete below:
School Name
Dates From

MonthDayYear
Date
To

MonthDayYear
Date
Address
Phone Number
Format: (000) 000-0000.
Reason for leaving
Owner/Manager
Age Group of Students:
School Name
Dates From

MonthDayYear
Date
To

MonthDayYear
Date
Address:
Phone Number:
Format: (000) 000-0000.
Reason for leaving:
Owner/Manager:
Age Group of Students:
Please list your GOALS as a martial artist.
References

Give three or more references that have known you for three or more years. Do not use relatives or former employers.
Reference #1 - Name
Address
Phone
Format: (000) 000-0000.
Occupation
Reference #2 - Name
Address
Phone
Format: (000) 000-0000.
Occupation
Reference #3 - Name
Address
Phone
Format: (000) 000-0000.
Occupation
Reference #4 - Name
Address
Phone
Format: (000) 000-0000.
Occupation
CERTIFICATION
I certify that my answers to the foregoing questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application form or during any interviews may be grounds for my immediate discharge.

I hereby authorize KICKSTART KIDS to contact any company or individual it deems appropriate to investigate my employment history, character and qualifications and

I give my full and complete consent to their revealing any and all information they wish as a result of this investigation. In addition, I hereby waive my right to bring any cause of action against these individuals for defamation, invasion of privacy or any other reason because of their statements.

I agree that, if I am employed, | will abide by all the rules and regulations of KICKSTART KIDS. I understand that the taking of drug and alcohol tests when given pursuant to company policy, are a condition of continued employment and refusal to take such tests when asked will be grounds for my immediate termination. I further understand that nobody in KICKSTART KIDS is authorized to enter into any written or verbal employment contracts with me for any definite period of time without the express written consent of the Executive Director of KICKSTART KIDS. I further understand that, if I am hired by KICKSTART KIDS, my employment will be terminable at will, that either KICKSTART KIDS or I may terminate the employment relationship at any time, for any reason and without advance notice, and that the at-will relationship can be changed only pursuant to a written agreement signed by the Executive Director of KICKSTART KIDS.
Signature
Date

MonthDayYear
Date
Should be Empty:

PERSONAL INFORMATION

ADDRESS INFORMATION

EMPLOYMENT DESIRED

EDUCATION

Military

CAPABILITY / RELIABILITY

WORK HISTORY

WORK HISTORY (Continued)

MARTIAL ARTS BACKGROUND

References

CERTIFICATION