EmpIoyment AppIication

AppIicant Information
Full Name: Date:
Last First M.I.
Address:
Street Address Apartment/Unit #

City State ZIP Code
Home
Phone: ( )
Cell
Phone: ( )
E-mail Address:
Position Applying for:
Are you a citizen of the United States?
YES

NO
Ìf no, are you authorized to work in the U.S.?
YES

NO

Have you ever been convicted of a felony?
YES

NO
Ìf yes, explain:

Are you currently employed? _____YES _____ NO May we contact your current employer? _____YES _____ NO

Name: ________________________________________________________ Phone: _______________________________


Fingerprinting or background checks wiII be required for aII empIoyees before your empIoyment begins.
If hired, pIease provide us with compIeted fingerprinting information.

Education
High School: Address:
From: To: Did you graduate?
YES

NO
Degree:
College: Address:
From: To: Did you graduate?
YES

NO
Degree:
Other: Address:
From: To: Did you graduate?
YES

NO
Degree:

References
Please list two professional references.
Full Name:
Relation
ship:
Company: Phone: ( )
Address:
Full Name:
Relation
ship:
Company: Phone: ( )
Address:
Urban Choice Charter SchooI
Redefining Urban Education
Urban Choice Charter SchooI
Redefining Urban Education



ExpIain in the space beIow why the Urban Choice Charter SchooI shouId hire you:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

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DiscIaimer and Signature

UCCS is committed to providing equal employment opportunity to all applicants for employment without regard to race,
color, religion, sex, age, national origin, disability, veteran status, marital status, sexual orientation, creed, or any other
applicable protected class status.

I hereby certify that the information presented on this form is true, accurate and complete. Any falsification,
misrepresentation or omission will be sufficient cause for disqualification and dismissal. References and personal
information which become part of this record are to be regarded as confidential and will not be revealed to me. I
understand that UCCS will conduct an inquiry regarding my background and experience and I authorize participating
schools and individuals to verify any and all information contained herein by any means possible. I knowingly and
voluntarily release from any and all liability anyone giving information regarding me so long as the information is
relevant to the duties for which I have applied.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.
Signature: Date:

Thank you!