Educational Services, Inc. :: Employee Leasing :: Business Services

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Educational Services, Inc.

Employment Application
Position:		Date Available:
Last Name:	First Name:	MI:	Today's Date:
Other Names Used:
Email Address:
Address Line 1:	Address Line 2:	City:	State:	Zip Code:	Home Phone:
Mailing Address Line 1:	Mailing Address Line 2:	City:	State:	Zip Code:	Other Phone:
Status of Authorization To Work in The United States?: Are you a Citizen or Other
Do You Have A Valid Driver's License?: Yes No	Driver's License Number:	Expiration Date:		State of Issue:

Education
Check Highest Level Completed
High School: 9 10 11 12		Graduate: Yes No		GED: Yes No
	Credit Hours
College or University Name and Location:	Sem:	Qtr:	Major:	Degree:

Other Training
Name and Address of School(s):	Course of Study:	Diploma/Certificate:

List Current Licenses/Professional Registration/Certifications/Memberships

Skills and Abilitites
Languages Spoken Fluently:	Languages Written Fluently:

List additional skills, training or experience that have provided you with the knowledge and abilitities for this position:

Current Employer
Employer:		Employment Dates: to
Your Job Title:		Part-time: Full-time:
Supervisor's Name:	Supervisor's Title:	Phone Number:
Brief Description of Work:		Starting Salary:
		Ending Salary:
Reason For Leaving:		May We Contact This Employer: Yes No

Previous Employer (if at current job less than 5 years)
Employer:		Employment Dates: to
Your Job Title:		Part-time: Full-time:
Supervisor's Name:	Supervisor's Title:	Phone Number:
Brief Description of Work:		Starting Salary:
		Ending Salary:
Reason For Leaving:		May We Contact This Employer: Yes No

References:
Please list the names and telephone numbers of three professional references (co-workers, customers and/or supervisors other than those listed in Employment History.
Name:	Relationship:	Telephone Number:

Miscellaneous:

Have you ever been convicted of a felony?* Yes No

If yes, give details including charges, dates and locations. A conviction will not necessarily desqualify and applicant from the position sought.

Details:

*Convicted of a felony means entry of a final judgment on a verdict or a finding of guilty, or a plea on nolo contendere, in a court of competent jurisdiction in a criminal case, regardless of whether an appeal is pending or could be taken. Conviction does NOT include a final judgment that has been expunged by pardon, set aside or otherwise rendered invalid.

Please Read Carefully:

Educational Services, Incorporated does not discriminate in hiring or in the terms or conditions of
employment on the basis of race, color, religion, sex, national origin, Vietnam-era veteran,
disability status, or sexual orientation. Federal law prohibits discrimination on the basis of age
against persons 40 or older. No question on this application is intended to secure information
to be used for such discrimination.

I authorize Educational Services, Incorporated to contact employers both past and present,
or any other person or entity that may have knowledge of my conduct, activities, or
credentials, in order for Educational Services, Incorporated to determine my eligibility
for employment. I understand all information will be maintained and treated by
Educational Services, Incorporated as confidential.

I certify that, to the best of my knowledge, all information given herewith is true. I understand
that any falsification or misrepresentation of facts will be a cause for dismissal if
Educational Services, Incorporated hires me.

Your Initials Indicate Signature of This Document

Date Signed

Educational Services, Inc.
info@educationalservicesinc.com
P.O. Box 235 Cottonwood AZ 86326
928.634.7639 or call toll-free 877.303.7639

Mohave Educational Services Cooperative
(MESC) Contract #02C-ESI-0524

Strategic Alliance for Volume Expenditures
(SAVE) Contract #400-28

Greater Phoenix Purchasing Consortium of Schools (GPPCS)

• EMPLOYEE LEASING • BUSINESS SERVICES • CONSULTING • FORMS • JOB POSTINGS • ABOUT • CONTACT • HOME •