Job Application Form

STAFF EMPLOYMENT APPLICATION
Full Name *

First Name Middle Name Last Name
Date of Application *

Month Day Year
Date
E-mail Address *
Cell Phone Number *
Residence *

Street Address

Apartment, Suite, Unit, etc. (optional)

City State

Zip Code
How Long at Current Residence? *
Available start date: *

Month Day Year
Availability Between the Hours of 2:30 and 5:30 p.m. *
Enter days of the week in which you are available to work
T-Shirt Size *

Adult Small Adult Medium Adult Large
Please feel free to attach a résumé and/or a summary of any additional information necessary to describe your full qualifications, interests, why you wish to work with children in this type of environment and why you would be an asset to the program.
How do you prefer to submit your resume?

Upload File Provide URL E-mail separately
Upload File
URL:
Website URL of your resume
EDUCATION EXPERIENCE
Name and Type of School
School Address

Street Address

Apartment, Suite, Unit, etc. (optional)

City State / Province

Postal / Zip Code
Degree/Diploma
List as many details as necessary
Name and Type of School
School Address

Street Address

Apartment, Suite, Unit, etc. (optional)

City State / Province

Postal / Zip Code
Degree/Diploma
List as many details as necessary
Name and Type of School
School Address

Street Address

Apartment, Suite, Unit, etc. (optional)

City State / Province

Postal / Zip Code
Degree/Diploma
List as many details as necessary
EXPERIENCE WORKING WITH CHILDREN
School/Organization
Employer Name

First Name Last Name
Employer E-mail Address
example@example.com
Responsibilities/Duties
Reason For Leaving
School/Organization
Employer Name

First Name Last Name
Employer E-mail Address
example@example.com
Responsibilities/Duties
Reason For Leaving
School/Organization
Employer Name

First Name Last Name
Employer E-mail Address
example@example.com
Responsibilities/Duties
Reason For Leaving
PROFESSIONAL REFERENCES

(at least two; not relatives)
Name

First Name Last Name
E-mail Address
example@example.com
Phone Number
Title
Years Known
Name

First Name Last Name
E-mail Address
example@example.com
Phone Number
Title
Years Known
Name

First Name Last Name
E-mail Address
example@example.com
Phone Number
Title
Years Known
LEGAL QUESTIONS/ NOTIFICATION

Please e-mail additional information, if necessary.
Have you ever been convicted of a criminal offense? *
If Yes, Please Explain
Have you ever been discharged or asked to resign from a prior position? *
If Yes, Please Explain
Are you presently being investigated or under a procedure to consider your discharge for misconduct by your present employer? *
If Yes, Please Explain
Are you a citizen of the United States? If not a citizen of the United States, do you intend to become a citizen of the United States? If you are not a United States citizen, have you the legal right to remain permanently in the United States? Do you intend to remain permanently in the United States? *
If No, Please Explain
An affirmative answer will not necessarily disqualify you from employment. Rather all pertinent information will be considered on a case-by-case basis to determine whether the nature and time of the offense (or alleged offense) are manifestly inconsistent with the duties of the position sought.
ADDITIONAL INFORMATION
The following questions are a very important part of the application process. Please reflect upon them carefully and give your candid responses to each of the questions below.
1. What are two or three of your most important reasons for wanting to be an after-school program assistant? *
2. In your previous work experiences, in what ways have you been most helpful to your employer? *
3. How do you feel about supervisors who have extremely high expectations of you? *
4. How much do you want to know about the children in order to be most helpful to them? *
5. What would you do if you lost order with a group of children? *
6. How would you react if you warned a child about his/her behavior and then had to follow through? *
7. Under what circumstances should you come into physical contact with a child? *
8. Is there anything in your background that would embarrass Mohr’s Explorers, LLC? *
DISCLOSURE REGARDING BACKGROUND INVESTIGATION

Mohr’s Explorers, LLC (“the Company”) may obtain information about you from a consumer reporting agency for employment purposes. Thus, you may be the subject of a “consumer report.” The consumer report may contain information regarding your criminal history and/or motor vehicle records (“driving records”) and may also contain other background information about you. As such, the consumer report may bear upon your character, general reputation, personal characteristics, and/or mode of living.
ACKNOWLEDGEMENT AND AUTHORIZATION REGARDING BACKGROUND INVESTIGATION
I acknowledge receipt of the following documents: DISCLOSURE REGARDING BACKGROUND INVESTIGATION, A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and ADDITONAL STATE LAW NOTICES. I certify that I have read and understand those documents.

I hereby authorize the obtaining of “consumer reports” about me by Mohr’s Explorers, LLC (”Company”) at any time during the hiring process and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer or insurance company to furnish any and all background information requested by SentryLink LLC, 7500 Greenway Center Drive, Suite 1040, Greenbelt, MD 20770, (877) 736-8791 with website www.sentrylink.com, another outside organization and/or Company itself.

I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.
Minnesota and Oklahoma Applicants or Employees ONLY: If you would like to receive a copy of a consumer report if one is obtained by the Company...
Please check here...
California Applicants or Employees ONLY: By signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW, and consent to the Company receiving “Investigative Consumer Reports” (as that phrase is defined by California law). If you would like to receive a copy of an investigative consumer report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under California law...
Please check here...
The following information is used for identification and statistical purposes. It is not used in any manner considered discriminatory under EEOC guidelines.
Date of Birth
Gender
Social Security Number
Full Name of Applicant

First Name Middle Name Last Name
Date

Month Day Year
Date
Signature of Applicant

Clear
It is the policy of Mohr’s Explorers, LLC that the best-qualified applicant shall be selected for each position without regard to race, color, religion, ethnic/national origin, age, gender, sexual orientation, physical or mental impairment, martial status or any other characteristic protected by applicable state, federal or local laws.
ADDITIONAL STATE LAW NOTICES

If you live in, work in, or are seeking work for Mohr’s Explorers, LLC (“the Company”) in Massachusetts, Minnesota, or New York, please note:

MASSACHUSETTS APPLICANTS/EMPLOYEES: You have the right to inspect and promptly receive a copy of any report requested by the Company by contacting the consumer reporting agency, SentryLink LLC, 7500 Greenway Center Drive, Suite 1040, Greenbelt, MD 20770, (877) 736-8791 with website www.sentrylink.com.

MINNESOTA APPLICANTS/EMPLOYEES: You have the right, upon written request, to receive a complete and accurate disclosure of the nature and scope of any consumer report by contacting the consumer reporting agency, SentryLink LLC, 7500 Greenway Center Drive, Suite 1040, Greenbelt, MD 20770, (877) 736-8791 with website www.sentrylink.com. The consumer reporting agency must make this disclosure within five days of receipt of your request or of Company’s request for the report, whichever is later.

NEW YORK APPLICANTS/EMPLOYEES: You have the right, upon request, to be informed of whether or not a consumer report was requested from a consumer reporting agency by contacting the consumer reporting agency, SentryLink LLC, 7500 Greenway Center Drive, Suite 1040, Greenbelt, MD 20770, (877) 736-8791 with website www.sentrylink.com. If a consumer report is requested, you will be provided with the name and address of the consumer reporting agency furnishing the report. You may inspect and receive a copy of the report by SentryLink LLCwith the contact information above.

Should be Empty:

STAFF EMPLOYMENT APPLICATION

EDUCATION EXPERIENCE

EXPERIENCE WORKING WITH CHILDREN

PROFESSIONAL REFERENCES

LEGAL QUESTIONS/ NOTIFICATION

ADDITIONAL INFORMATION

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

ACKNOWLEDGEMENT AND AUTHORIZATION REGARDING BACKGROUND INVESTIGATION

ADDITIONAL STATE LAW NOTICES