Employment - Sunshine Learning Center

Introduction & Instructions
Any applicant who knowingly or willfully makes a false statement of any material fact or thing in the application is guilty of perjury in the second-degree as defined in section 18-8-503, CRS, and upon conviction thereof, shall be punished accordingly and may be terminated.

Please omit any information which indicates your age, race, creed, sex, marital status, color, or nationality. Sunshine Learning Center is an equal opportunity employer.
Personal Information
Name*
First Middle Last
Email*
Date of Birth*
Month & Day ONLY
Phone Number*
Present Address*
Street Address Address Line 2 City State ZIP Code
Do you have a different Permanent Address?*
- Yes
- No
Permanent Address*
Street Address Address Line 2 City State ZIP Code
Church Affiliation*
Do you have any disabilities that would require accommodations if hired?*
- Yes
- No
Please list any disabilities and associated accommodations*
Are you prevented from becoming employed in this country because of a Visa or Immigration Status?*
- Yes
- No
Emergency Contact*
First Last
Relationship*
Phone*
Is your emergency contact's address the same as your Present Address?*
- Yes
- No
Emergency Contact's Address*
Street Address Address Line 2 City State ZIP Code

Employment History
Please list your last three employers, starting with the most recent.
Company Name*
Position*
Location*
City State
Dates Employed*
Please provide at least month and year.
Reason for leaving*
Company Name*
Position*
Location*
City State
Reason for leaving*
Dates Employed*
Please provide at least month and year.
Company Name*
Position*
Location*
City State
Dates Employed*
Please provide at least month and year.
Reason for leaving*

Education Level	Name & Location of School (City & State)	Years Attended	Year Graduated	Subjects Studied

Introduction & Instructions

Name	Address (City & State)	Phone Number	Years Known