Staff Application Questions

Name as it appears on your passport*

First Name

Last Name

Maiden Name

Do you have any other aliases or other names?*

Yes No

If yes please list

Personal Email*

Permanent Address

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

How many years have you lived here?

If less than one year, please put 0 (zero)

If less than 5 years, please include all previous addresses and how long you have lived there.

Contact Information

Are you legally married?*

Yes No

Spouses Name?

Date Married?

Do you have any children?*

Yes No

List their names and age, one per line

Do any of your children live with you?

Yes No

If yes, please list their names below

Please list two emergency contacts who do not live with you

Contact 1*

First Name

Last Name

Relationship

Phone Number

E-mail address

Physical Address

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Contact 2

First Name

Last Name

Relationship

Phone Number

E-mail address

Physical Address

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Travel Documents

Do you have a drivers license?*

Yes No

Is it valid internationally?

Yes No

License Number:

Country Issued

State Issue

Do you have a passport?*

Yes No

Passport Country

Passport Number

Passport Expiration Date

Have you ever been deported from a country?*

Yes No

If yes, please explain

Please list all visas that you currently have with expiration dates below

Visa #1 with Expiration

Visa #2 with Expiration

Visa #3 with Expiration

Visa #4 with Expiration

Visa #5 with Expiration

Military Service

Have you ever been in the armed forces?*

Yes No

If yes, for which country?

Are you a reserve?

Specialty:

Date Entered / Date Discharged?

Were you honorably discharged?

Yes No

Employment Application Disclaimer and Acknowledgement

I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify/misrepresent/mislead/conceal information is grounds for refusing to hire me, or for discharge should I be hired. I understand that if any of the information on this application is to change during the application process or once hired I am required to notify the company within 7 days. Failure to notify the company within 7 days is grounds for refusing to hire me, or for discharge should I be hired. I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for employment. I also authorize you to request and receive such information. In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added or interpreted at any time, at the company’s sole option and without prior notice to me. I also acknowledge that my employment may be terminated, or any offer or acceptance of employment withdrawn, at any time, with or without cause, and with or without prior notice at the option of the company or myself. Faculty Handbook is provided for all other employment details.

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Contact Information

Travel Documents

Military Service

Employment History

Financial History

Personal History

Employment Application Disclaimer and Acknowledgement