Application

Kicks Karate Pre-Employment Application

Our Company is an equal opportunity employer and will consider all applicants for all positions equally without regard to their race, sex, age, color, religion, national origin, veteran status or any disability as provided in the Americans With Disabilities Act.

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 an NA for that question.

Name:

Date if Birth:

Phone:

Fax:

E-mail Address:

Current Address:

City:

State:

Zip:

Previous Address:

City:

State:

Zip:

Are you over 18?

Yes No

Are you a citizen of the U.S

Yes No

If you are not a U.S. citizen, do you have the legal right to be employed in the United States?

Yes No

Have you ever been convicted of any crime (excluding minor traffic violations including driving while under the influence of alcohol or drugs?)

Yes No

If yes, state the offense, location, date and disposition below. Note: A conviction will not necessarily disqualify you from employment

EMPLOYMENT DESIRED:

Are you seeking

	Full-time
	Part-time
	Temporary or summer employment?

Position applied for

Salary Desired $

Date available to start

Have you ever applied to our company before?

Yes No

Have you ever worked for our company before?

Yes No

If your answer yes to either question 11 or 12, state when and where you applied and/or worked.

EDUCATION:

Please fill out the name of your High School and College, plus years attended below

Are you planning to pursue further studies?

Yes No

If so, when, where and what courses?

List and describe any other school or specialized studies.

MILITARY:

Have you ever served in the military?

Yes No

Service Branch:

Date Entered:

Type of discharge:

Date Separated:

Final Rank:

CAPABILITY/ RELIABILITY:

Will you abide by the policies of this company?

Yes No

Have you ever been disciplined for violating a former employers safety rules or regulations?

Yes No

If yes, please explain:

Would you be willing and able to report to work on time every day on a regular and consistent basis?

Yes No

WORK HISTORY:

List names of employers in consecutive order with present or last employer listed first. Please give month and year. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references.

CURRENT EMPLOYER:

Name of Employer:

Address:

Dates of Employment:

Phone Number:

Supervisor:

Your Job Title:

Annual Salary:

Reason for leaving:

Duties:

Are you presently employed?

Yes No

If yes, may we contact your present employer?

Yes No

Have you ever been fired or asked to resign?

Yes No

If yes, please explain

SPECIAL SKILLS:

Use the space below to describe why you are interested in working for our company and to list those skills and abilities which you feel particularly qualify you for a position with us.

REFERENCES:

Give three references that have known you for three or more years. Do not use relatives or former employers. Please include, name, address, phone number and occupation.

By clicking on the SUBMIT button, 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 Kicks Karate to contact any company or individual it deems appropriate to investigate my background, employment history, character and qualifications, and I give my full and complete consent to their revealing any and all information they wish to Kicks Karate during 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, I will abide by all the rules and regulations of Kicks Karate. I further understand that nobody in Kicks Karate 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 Kicks Karate