Employment - Sunshine Learning Center

Introduction & Instructions
Any applicant who knowingly or willfully makes a false statement of any material fact or thing in the application is guilty of perjury in the second-degree as defined in section 18-8-503, CRS, and upon conviction thereof, shall be punished accordingly and may be terminated.

Please omit any information which indicates your age, race, creed, sex, marital status, color, or nationality. Sunshine Learning Center is an equal opportunity employer.
Personal Information
Name*
First Middle Last
Email*
Date of Birth*
Month & Day ONLY
Phone Number*
Present Address*
Street Address Address Line 2 City State ZIP Code
Do you have a different Permanent Address?*
- Yes
- No
Permanent Address*
Street Address Address Line 2 City State ZIP Code
Church Affiliation*
Do you have any disabilities that would require accommodations if hired?*
- Yes
- No
Please list any disabilities and associated accommodations*
Are you prevented from becoming employed in this country because of a Visa or Immigration Status?*
- Yes
- No
Emergency Contact*
First Last
Relationship*
Phone*
Is your emergency contact's address the same as your Present Address?*
- Yes
- No
Emergency Contact's Address*
Street Address Address Line 2 City State ZIP Code

Desired Employment
Desired Position*
Desired Salary*
Available Start Date*
MM slash DD slash YYYY
Are you currently employed?*
- Yes
- No
May we contact your current employer?*
- Yes
- No
Who were you referred by?*
Please enter a person's name or where you saw the job posting.

Education

Education History*

Starting with high school, please list each level of education completed. Click the PLUS SIGN to add a new row

Education Level	Name & Location of School (City & State)	Years Attended	Year Graduated	Subjects Studied

Please provide any special skillsets.*
Please provide any applicable activities and organizations.*

Employment History
Please list your last three employers, starting with the most recent.
Company Name*
Position*
Location*
City State
Dates Employed*
Please provide at least month and year.
Reason for leaving*
Company Name*
Position*
Location*
City State
Reason for leaving*
Dates Employed*
Please provide at least month and year.
Company Name*
Position*
Location*
City State
Dates Employed*
Please provide at least month and year.
Reason for leaving*

References

Reference Contacts*

Please list 3 references, not related to you, whom you have known for at least one year. by listing these personas as references, you give Sunshine Learning Center permission to contact them. Click the PLUS SIGN to add a new row

Name	Address (City & State)	Phone Number	Years Known

Acknowledgement
By signing this form, you acknowledge:*
1. To the Best of my knowledge, I have had all my childhood immunizations.
2. I affirm that I am not, to my knowledge, listed on the Colorado Central Registry nor have I ever been convicted of a felony crime involving child abuse/neglect.
3. I hereby state that I have no physical or mental conditions that would prevent me from performing any part of my duties including the lifting of small children, some pickup and moving of furniture or other needed equipment, and in the evacuation of the premises in case of an emergency.
4. In Colorado, employment is "at will". Employees may be terminated without cause.

Step 1 of 6

Introduction & Instructions

Personal Information

Desired Employment

Education

Employment History

References

Acknowledgement