SUBCONTRACTOR APPLICATION
PERSONAL INFORMATION
Are you a citizen of the United States ? Yes No
If no, are you authorized to work in the US ? Yes No
Have you ever been convicted of a felony ? Yes No
If Yes, explain
EDUCATION
Did you graduate ? Yes No
Did you graduate ? Yes No
Did you graduate ? Yes No
EMPLOYMENT HISTORY (BEGIN WITH LAST EMPLOYER FIRST)
MILITARY SERVICE
If other than honorable explain
PROFESSIONAL REFERENCES
May we contact your previous supervisor for a reference ? Yes No
May we contact your previous supervisor for a reference ? Yes No
May we contact your previous supervisor for a reference ? Yes No
DISCLAIMER AND SIGNATURE
I certify that the facts contained in the application are true and complete to the best of my knowledge and understand that, if employed, part time full time , or hired on a contract basis, falsified statements shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers previously listed to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company for all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the American with Disabilities Act. (ADA) and other relevant federal and state laws.
Please briefly explain why you are interested in working with children with special needs, citing any interests or experience that would benefit your performance. Include volunteer work, camps, not for profit events, workshops, seminars, and any classes taken which further support your interests.
