Online Application

Today's Date*
Full Name *
First Name
Middle
Last Name
Current Address *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Home Phone #*
Cell Phone #
Email Address
Are you under 18 years old?*
Are you a US citizen legally eligible to work in the US?*
Have you ever been convicted of a crime?*
If yes, please explain below:
Position Applying For? (Select from drop down menu) *
Full Time/Part Time?
Desired Wage?*
Highest level of education? (Select from drop down menu)
Do you have your 90 Clock Hour Certification?
Work Experience (Employer #1)
Work Experience #1 Dates Employed
Work Experience #1 Address
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Work Experience #1 Phone Number
Work Experience #1 Supervisor Name
May we contact this employer for a reference?
Work Experience #1 Job Title
Work Experience #1 Last Rate of Pay
Work Experience #1 Reason for Leaving:
Work Experience (Employer #2)
Work Experience #2 Dates Employed
Work Experience #2 Address
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Work Experience #2 Phone Number
Work Experience #2 Supervisor Name
May we contact this employer for a reference?
Work Experience #2 Job Title
Work Experience #2 Last Rate of Pay
Work Experience #2 Reason for Leaving:
Right Start Academy does not discriminate on the basis of race, age, religion, national origin, marital status, disability, sex, sexual preference, status with regard to public assistance, or any other basis protected by law.
UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100. I certify that all information provided in this application material is true. I understand that any false statement made herein is sufficient reason for rejection of this application or termination of subsequent employment regardless of date of discovery.
Electronic Signature (Type Name)*