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Arizona Upgrade Academy Employment Application
Arizona Upgrade Academy
327 S. 15th Street
Cottonwood, AZ 86326
Phone (928)634-3722
Fax (928)634-3695
Applicant Information:
Social Security # _______-______-_______ DOB________________ Today’s Date______________
Name: ____________________________________________________________________________
(Last / First / Middle)
Present Address: __________________________________________________________________________________
(No. Street / City / State / Zip)
How long have you lived at this address? _________
Permanent Address if different from above: __________________________________________________________________________________
(No. Street / City / State / Zip)
Telephone: (_____) ________-___________ (Day)
Telephone: (_____) ________-___________ (Night)
Email Address: _____________________________________________________________________
Are you 18 years of age or older? __Yes __ No
Do you possess a valid fingerprint card?__________ Please include a photocopy of the card.
By law, employees of Arizona Upgrade Academy must possess a valid fingerprint card.
EMPLOYMENT
Position for which you are applying __________________________________________
When could you begin work?________________
How Were You Referred To Our Organization? ________________________________
Do You Have Any Relatives Who Are Employed By This Organization? __Yes __No
Please Specify : _________________________________________________________
Is there any information we would need about your name, or use of another name, for us to be able to check your work record? __Yes __ No
Please Specify : _________________________________________________________
Please list any additional information that relates to your ability to perform the job for which you have applied such as licenses, professional memberships, hobbies, etc.
____________________________________________________________________________________________________________________________________________________________________
EDUCATION
Type Name/Location Course of Study Yrs Completed Degree/Diploma
HighSchool ______________
College _______________ ______________ ___________ __________________
College _______________ ______________ ___________ __________________
College _______________ ______________ ___________ __________________
Technical _______________ ______________ ___________ __________________
Other related Training:_____________________________________________________________
_________________________________________________________________________________
EMPLOYMENT RECORD
Please list your Current/most recent job held first:
- Name of Employer _____________________________
Dates of employment: ________ to ________
Address _______________________________________ Phone Number _______________________
Your job title ________________________________________________
Name of last supervisor _______________________________________
Supervisor's telephone number _________________________________
May we contact your current employer? ____yes ____no
Duties, skills, advancements, or promotions related to this position: ____________________________________________________________________________________________________________________________________________________________________
Reason for leaving __________________________________________________________________________________
- Name of Employer _____________________________
Dates of employment: ________ to ________
Address _______________________________________ Phone Number _______________________
Your job title ________________________________________________
Name of last supervisor _______________________________________
Supervisor's telephone number _________________________________
May we contact your current employer? ____yes ____no
Duties, skills, advancements, or promotions related to this position: ____________________________________________________________________________________________________________________________________________________________________
Reason for leaving __________________________________________________________________________________
- Name of Employer _____________________________
Dates of employment: ________ to ________
Address _______________________________________ Phone Number _______________________
Your job title ________________________________________________
Name of last supervisor _______________________________________
Supervisor's telephone number _________________________________
May we contact your current employer? ____yes ____no
Duties, skills, advancements, or promotions related to this position: ____________________________________________________________________________________________________________________________________________________________________
Reason for leaving __________________________________________________________________________________
- Name of Employer _____________________________
Dates of employment: ________ to ________
Address _______________________________________ Phone Number _______________________
Your job title ________________________________________________
Name of last supervisor _______________________________________
Supervisor's telephone number _________________________________
May we contact your current employer? ____yes ____no
Duties, skills, advancements, or promotions related to this position: ____________________________________________________________________________________________________________________________________________________________________
Reason for leaving __________________________________________________________________________________
REFERENCES
Please list at least three references, other than relatives or previous employers.
Name _____________________________________________________________________________
Address ___________________________________________________________________________
Phone _____________________________________________________________________________
E-mail address ______________________________________________________________________
Relationship to you __________________________________________________________________
Name _____________________________________________________________________________
Address ___________________________________________________________________________
Phone _____________________________________________________________________________
E-mail address ______________________________________________________________________
Relationship to you __________________________________________________________________
Name _____________________________________________________________________________
Address ___________________________________________________________________________
Phone _____________________________________________________________________________
E-mail address ______________________________________________________________________
Relationship to you __________________________________________________________________
Have you ever been convicted of a felony? ___Yes ___No
If yes, please attach a document containing date(s), type of conviction(s), and sentence.
If hired, can you provide written evidence that you are authorized to work in the U.S.? __ Yes __No
Do you possess a valid U.S. driver's license? ___Yes ___No State ____________________
APPLICANT'S STATEMENT
I understand that Arizona Upgrade Academy follows an "employment at will" policy, in that I or Arizona Upgrade Academy may terminate my employment at any time, or for any reason consistent with applicable state or federal law; this "employment at will" policy cannot be changed verbally or in writing, unless the change is specifically authorized in writing by the Director of this organization. I understand that this application is not a contract of employment. I understand that federal law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and identity; failure to submit such proof will result in denial of employment.
I understand that Arizona Upgrade Academy will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms named therein, except my current employer if so noted, to provide any information requested about me and I release them from all liability for damage in providing this information. I understand Arizona Upgrade Academy may, as part of its routine screening process, request from a consumer credit reporting agency an investigative consumer report including information as to my credit records and general reputation. Upon written request from me, Arizona Upgrade Academy will provide me with information concerning the nature and scope of any such report it requests, as required by the Fair Credit Reporting Act.
I understand that if I am hired, my continued employment may be conditioned upon Arizona Upgrade Academy’s receipt of satisfactory reports from background checks. I understand this application will be active for a period of one year; after that time, if I wish to be considered for employment, I must submit a new application. I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment.
Your Signature: ______________________________________________ Date: _______________
Arizona Upgrade Academy is an equal employment opportunity employer. It is our policy to make
Employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age, veteran status, or disability. Your opportunity for employment with this organization depends solely on your qualifications.
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