Waterfall Canyon Academy | Application Form

Date*

Name*

FIRST MIDDLE LAST NAME

Social Security No.*

SSN#

Present Address*

ADDRESS CITY STATE ZIP

Permanent Address (If different than above)

ADDRESS CITY STATE ZIP

Home Phone #

Cell Phone #

Email Address*

ARE YOU A UNITED STATES CITIZEN?*

YES
NO

VISA TYPE:*

VISA NUMBER:*

EXPIRATION*

Required Documents

If hired, the following documents will be required within 7 days.

Copy of MVR or personal driving record

*Please bring MVR or upload to website prior to your interview.

Background Check Application
Certified Court Dockets of any and all criminal charges
2 Fingerprint Cards (Can be obtained from our office.)
Current Driver's License or State ID
Social Security Card
TB Test
Food Handler's Permit

POSITION INFORMATION

Position Applied For*

Referral Source

Advertisement (Specify)

Placement Service (Specify)

School (Specify)

Other

Are you willing to work ANY shift, including weekends?*

YES
NO

Indicate shift(s) you will HAPPILY work*

Day
Swing
Graveyard
Weekdays
Weekends

**This does not guarantee the attainment of preferred shifts.**

Additional comments regarding your availability

Have you ever been employed by the company?*

YES
NO

If so, when?*

Where?*

Are any relatives, including in-laws, employed by the company?*

YES
NO

If so, give name, relationship, position and job location*

Have you ever previously applied for employment at the company?*

YES
NO

If so, when?*

Have you previously interviewed with the company?*

YES
NO

If so, when?*

By whom?*

For what position?*

EDUCATION

High School*

Name and Location

*

Graduated

YES
NO

College or University

Name and Location

Major

Graduated

YES
NO

College or University

Name and Location

Major

Graduated

YES
NO

Other (Technical, Vocational, Graduate, etc.)

Name and Location

Graduated

YES
NO

List any scholarships, academic honor, awards, or special achievements

List languages, other than English, in which you can converse

Fluent?

YES
NO

Fluent?

YES
NO

EMPLOYMENT HISTORY

IMPORTANT! Starting with your present or most recent employer, list in consecutive order all employment and periods of unemployment since you graduated or last attended high school. Additional employment may be listed on a separate page if necessary.

PRESENT OR MOST RECENT EMPLOYER

FULL NAME OF COMPANY

TELEPHONE

SALARY (Begin/End)

DATES EMPLOYED (Begin/End)

Address

STREET ADDRESS CITY STATE ZIP CODE

NAME & TITLE OF SUPERVISOR

REASON FOR LEAVING

TITLE OF YOUR POSITION

DEPARTMENT

JOB DUTIES

May we contact this employer?

YES
NO

PREVIOUS EMPLOYER

FULL NAME OF COMPANY

TELEPHONE

SALARY (Begin/End)

DATES EMPLOYED (Begin/End)

Address

STREET ADDRESS CITY STATE ZIP CODE

NAME & TITLE OF SUPERVISOR

REASON FOR LEAVING

TITLE OF YOUR POSITION

DEPARTMENT

JOB DUTIES

May we contact this employer?

YES
NO

PREVIOUS EMPLOYER

FULL NAME OF COMPANY

TELEPHONE

SALARY (Begin/End)

DATES EMPLOYED (Begin/End)

Address

STREET ADDRESS CITY STATE ZIP CODE

NAME & TITLE OF SUPERVISOR

REASON FOR LEAVING

TITLE OF YOUR POSITION

DEPARTMENT

JOB DUTIES

May we contact this employer?

YES
NO

Have you experienced periods of unemployment within the last 5 years?*

YES
NO

If yes, please explain*

Have you ever been suspended, placed on probation, asked to resign, discharged or terminated?*

YES
NO

If yes, please explain*

SKILLS

List any skills you think may be of value to the company.

MISCELLANEOUS INFORMATION

Do you have a valid driver's license?*

YES
NO

LICENSE NUMBER*

STATE*

EXPIRATION DATE*

Have you ever been charged with a crime for any violation of the law?*

YES
NO

If yes, give full particulars (The existence of a criminal record does not constitute an automatic bar to employment)*

Copy of court documents will be required if hired.

REFERENCES

Waterfall Canyon Academy/OakGrove School requires three (3) references of people who have known you for at least two years. Please make your references people not related to you, who have employed you or know of your skills and experience working in this field.

FIRST REFERENCE

Name*

Address*

Phone #*

Nature of Relationships*

Years of Acquaintance*

** TO BE COMPLETED BY INTERVIEWER **

Comments

Contacted By

(Supervisor Sign or Initial)

Date of Contact

SECOND REFERENCE

Name*

Address*

Phone #*

Nature of Relationships*

Years of Acquaintance*

** TO BE COMPLETED BY INTERVIEWER **

Comments

Contacted By

(Supervisor Sign or Initial)

Date of Contact

THIRD REFERENCE

Name*

Address*

Phone #*

Nature of Relationships*

Years of Acquaintance*

Comments

** TO BE COMPLETED BY INTERVIEWER **

Contacted By

(Supervisor Sign or Initial)

Date of Contact

APPLICANT'S CERTIFICATION AND AGREEMENT

I HEREBY CERTIFY my answers to the foregoing questions are true and complete and I have not knowingly withheld any facts, circumstances or other information that would, if disclosed, affect my application. I further understand any false or misleading statement or omission of pertinent information will result in the rejection of my application, or in dismissal if discovered subsequent to my employment.

I HEREBY AFFIRM that by execution of the application I acknowledge the Company has disclosed to me that an investigative Consumer Report, including information as to my character, general reputation, personal characteristics, and mode of living may be made, and I, upon written request to the Company made within a reasonable time after the date of this application may obtain a complete and accurate disclosure of the nature and scope of the investigation requested.

I HEREBY AUTHORIZE the Company to request, and I ALSO AUTHORIZE AND REQUEST each former employer, school attended, and each person, firm, or corporation given as references above, to furnish at any time, any information which may be sought concerning me and my work habits, character or skill, and any other data required, whether in connection with this application or for purposes of complying with surety company requirements or otherwise.

I HEREBY AFFIRM by submitting this application I agree to medical evaluations and/or examinations, including tests for the presence of illegal drugs or alcohol, prior to and during employment, within a time period prescribed by the Company and as often as directed during employment.

I HEREBY AUTHORIZE the medical examiner to disclose to the Company any and all findings and conclusions arrived at in any examination performed either prior to employment or during employment.

I UNDERSTAND should I be given employment, such employment shall be for an indefinite period of time and may be terminated, at will, at any time, for any reason, by me or the Company without notice or without liability whatsoever, except for unpaid wages or salary earned by the date of termination. I further understand only the General Manager of the Company has the authority to enter into any agreement for employment for a specified period of time or to make any agreement contrary to this at will standard and any such agreement must by in writing.

I UNDERSTAND if I am employed, the terms and conditions of my employment will be governed by this application and the Company's Terms of Employment and Policy and Procedures, as amended from time to time by the Company.

The company operates under the principles of affording equal employment opportunity through affirmative action for qualified handicapped individuals, qualified veterans of the Vietnam era and qualified disabled veterans.

All applicants and employees who believe themselves to be members of one or more of these groups, and who wish to identify themselves as such for the purpose of affirmative action consideration are invited to do so.

Submission of this information is voluntary and refusal to provide it will not subject you to discharge or disciplinary treatment. Information obtained concerning individuals shall be kept confidential, except (1) supervisors and managers may be informed regarding disabled veterans and handicapped individuals, as necessary, (2) first aid and safety personnel may be informed, when and to the extent appropriate, if the condition might require emergency treatment, and (3) governmental officials investigating compliance will be informed.

I wish to volunteer the following information (check one)*

I do qualify under the following:

I do not qualify
Handicapped
Vietnam Era Veteran
Disabled Veteran

Signature

Date

Thank you for completing this application. It will remain under consideration for ninety days. It will not be necessary for you to reapply during this ninety-day period. Your interest in Waterfall Canyon Academy/OakGrove School is appreciated.

Untitled

Comments

This field is for validation purposes and should be left unchanged.

Online Application Form

Required Documents

POSITION INFORMATION

EDUCATION

EMPLOYMENT HISTORY

PRESENT OR MOST RECENT EMPLOYER

PREVIOUS EMPLOYER

PREVIOUS EMPLOYER

SKILLS

MISCELLANEOUS INFORMATION

REFERENCES

FIRST REFERENCE

SECOND REFERENCE

THIRD REFERENCE

APPLICANT'S CERTIFICATION AND AGREEMENT

Affiliate Links

Quick Links

Latest News

Maps & Directions