Once Upon A Child Job Application – Fill Out and Use

APPLICATION

FOR

EMPLOYMENT

We at Once Upon A Child are committed to a policy of equal treatment and opportunity in every aspect of our employment relations without regard to race, color, religion, sex, national origin, age, disability, or any other legally protected class status. This includes, but is not limited to, recruiting, hiring selection for training, transfers, promotion, compensation, and any company sponsored social and recreational programs.

PLEASE PRINT

Name _______________________________________________________________________ Date ________________________________________

Present Address ___________________________________________________________________________________________________________

		Street			City	State	Zip
Social Security #_______________________________________________________________ Telephone (___)______________________________
Referred by	Advertisement	Agency	Person	Other _________________________________________________
Are you legally eligible for employment in the U.S.A.?			Yes	No	State age if under 18	___________________________________

Position applying for _______________________________________________________________ Salary expected _________________________

Are you available to work Full-time Part-Time Specify schedule limitations ___________________________________________

Date available for work _______________________________ List friends or relatives in our employ _____________________________________

Were you previously employed by us? Yes No If yes, when _______________________________________________________

Other name(s) used while attending schools or places of employment indicated on this form ______________________________________________

Can you perform the functions of this job with or without reasonable accommodations?

Yes No If No, please explain: ___________________________________________________________________________________

_________________________________________________________________________________________________________________________

Have you ever been convicted of a felony? Yes No

If yes, please explain: (Note - A conviction alone will not automatically bar you from

employment.) _________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Military Service? Yes No Branch of service and rank _______________________Dates of Service______________________________

Special Training ___________________________________________________________________________________________________________

EDUCATION

Name and Location	Course	Scholastic	Dates of		Graduated
	of Study	Average	Attendance
				Yes/No	Mo/Year	Degree
High School/GED			N/A		N/A
College
Vocational
Other

Additional comments regarding education ______________________________________________________________________________________________

________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________

SKILLS

List Computer Software Packages in which you are proficient _____________	What languages do you:
______________________________________________________________	speak fluently ______________________________
Cash Register ___________________________ 10-Key _________________	write fluently _______________________________
Other Skills _____________________________________________________	read fluently _______________________________

EMPLOYMENT HISTORY

(List present or most recent employer first)

Name of Company __________________________________ Address ________________________________________________________________

Supervisor _________________________________________ Salary _______________ Phone ____________________________________________

Job Title ________________________________________________________ Date Started __________________ Date Left ___________________

Job Description ___________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Reason for Leaving:

Name of Company __________________________________ Address ________________________________________________________________

Supervisor _________________________________________ Salary _______________ Phone ____________________________________________

Job Title _________________________________________________________Date Started __________________ Date Left ___________________

Job Description ___________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Reason for Leaving:

Name of Company __________________________________ Address ________________________________________________________________

Supervisor _________________________________________ Salary _______________ Phone ____________________________________________

Job Title _________________________________________________________Date Started __________________ Date Left ___________________

Job Description ____________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Reason for Leaving:

Name of Company __________________________________ Address ________________________________________________________________

Supervisor _________________________________________ Salary _______________ Phone ____________________________________________

Job Title _________________________________________________________Date Started __________________ Date Left ___________________

Job Description ____________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Reason for Leaving:

AUTHORIZATION FOR BACKGROUND CHECK: I authorize Once Upon A Child to verify employment, except as noted below, as well as conduct criminal and vehicular record check.

Indicate those you do not wish contacted:________________________________________________________________________________________

Signed: ______________________________________________________________________________Date: _______________________________

REFERENCES

Please list three persons other than relatives or personal friends, who can judge your work ability.

1)Name _________________________________________________________ Occupation ______________________________________________

Address ______________________________________________________________________ Phone ____________________________________

2)Name _________________________________________________________ Occupation ______________________________________________

Address ______________________________________________________________________ Phone ____________________________________

3)Name _________________________________________________________ Occupation ______________________________________________

Address ______________________________________________________________________ Phone ____________________________________

Please use the space provided below to summarize any additional information necessary to fully describe your qualifications.

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

PLEASE READ

All information written on this application is complete and accurate to the best of my knowledge. I understand that any misrepresentation of facts in this application disqualifies me from further consideration - or if employed - is grounds for dismissal. I understand that any employment offer is contingent upon satisfactory references and I authorize Once Upon A Child to investigate past employment and education history, as well as references given on application.

I understand that if employed such employment may be terminated for just cause, or no cause, by Once Upon A Child or myself at any time. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than its Owner, and then only when in writing and signed by the Owner, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

I fully understand and agree to all statements above.
_______________________________________________________	_________________________________________________
Signature	Date

OFFICE USE ONLY

Interviewed by _____________________________________________________________________ Date __________________________________

Referral Source _______________________________________________________________ Hired _________________ Not Hired _____________

Starting Date ___________________________ Position ________________________________________________ Salary _____________________

Location ______________________________________

Reporting To ___________________________