Employment Application

Employment Application

L.B.J.& C. Head Start is an Equal Opportunity Employer.
Name

First NameMiddle InitialLast Name
Mailing Address:

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
Home Email Address:
example@example.com
Position Applying For:
Desired Location (Centers by county):
Select all that apply.
Do you have relatives working for L.B.J.& C. serving on its Board or Policy Council?
If Yes, Relationship/Name of Person
Are you
Emergency Contact:
Relation:
Emergency Contact Phone Number:
Format: (000) 000-0000.
Do you have a valid Driver's License?
Have you ever been convicted of a Felony?
If Yes, list all:
How did you hear about this job?
By entering an electronic signature below:

I certify that the information given by me in this application is true in all respects; and I agree that, if employed, the information is found to be false in any way, that I may be subject to dismissal without notice.

I am aware that the results of the Criminal History Background Check will be a determining factor on being hired on a regular basis.

I authorize the use of any information in this application to verify my statements, and authorize past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record.

All persons furnishing information are released from any liability or damages.
Signature of Applicant
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
RESUME IS REQUIRED: The resume must include your highest education level; employment history that includes names, addresses, and phone numbers; and personal references that includes names, addresses, and phone numbers of three (3) persons not related to you.

Cancelof
Unsigned or Incomplete Applications Will Not Be Considered
Employment Application
Should be Empty: