Elks Aidmore Children's Center:: JOB OPPORTUNITIES

2394 Morrison Road
Conyers, GA 30094
P: 770.483.3535
F: 770.483.5696

EMPLOYMENT APPLICATION
Be advised that the policy of Elks Aidmore, Inc. is to verify information given in this application by investigation, truth verification where available, physical examination, illegal drug screening, handwriting analysis and police background checks. I understand that, if hired, I may be required to consent to truth verification tests, where legal, and illegal drug screening, if necessary, for agency security investigations. Refusal to consent to legal testing may be grounds for termination.

Name: (first, middle, last name)
(required)

Address:
(street, city, state, zip)

How many years have you lived at your present address?

Contact phone number:
(required)

E-mail:

Are you an American Citizen?
yes no

If not, do you have the proper work authorization?
yes no

Do you have any military experience?
yes no

Discharged: honorable dishonorable

Have you ever been arrested?
yes no

If yes, explain:

How did you learn of this opening?

Please list any friends or family working for Elks Aidmore:

In case of Emergency Contact (list name & phone number):

Position you're applying for:

Expected Salary:

Please list your schooling:

Dates attended (from/to):
School Attended:
Location:
Degree:

* * * * * * * * * * * *

Dates attended (from/to):
School Attended:
Location:
Degree:

* * * * * * * * * * * *

Dates attended (from/to):
School Attended:
Location:
Degree:

* * * * * * * * * * * *

Dates attended (from/to):
School Attended:
Location:
Degree:

Please list present or most recent employer first :

Date (from/to):
Name and Address of Employer:
Contact Phone of Employer:
Type of Work You Did:
Immediate Supervisor:
Supervisor's Position:
Weekly Salary:
Reason for leaving:
IF NOW EMPLOYED, MAY WE CONTACT YOUR EMPLOYER WITHOUT JEOPARDIZING YOUR JOB? yes no

* * * * * * * * * * * *

Date (from/to):
Name and Address of Employer:
Contact Phone of Employer:
Type of Work You Did:
Immediate Supervisor:
Supervisor's Position:
Weekly Salary:
Reason for leaving:

* * * * * * * * * * * *

Date (from/to):
Name and Address of Employer:
Contact Phone of Employer:
Type of Work You Did:
Immediate Supervisor:
Supervisor's Position:
Weekly Salary:
Reason for leaving:

* * * * * * * * * * * *

Date (from/to):
Name and Address of Employer:
Contact Phone of Employer:
Type of Work You Did:
Immediate Supervisor:
Supervisor's Position:
Weekly Salary:
Reason for leaving:

Please list three personal references and a contact phone number for each.

1.	Phone:
2.	Phone:
3.	Phone:

By submitting this application you hereby certify that the facts set forth in the above employment application are true and complete to the best of your knowledge. You understand that falsified statements on this application will be sufficient reason or rejection of your application or, if hired, termination of employment.