KINETIC MINDS, INC. APPLICATION FOR EMPLOYMENT APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS DATE Name Last First Middle Maiden Present address Number Street City State Zip How long ____________________ Social Security No. _______ _____ _________ – – Home phone ( ) ___ Date of Birth _________________________ Cell phone ( ) ___ If under 18, please list age _____________ Email Address ___________________ Days/hours available to work Position applied for (1) No Pref Thur and salary desired (2) Mon Fri Tue Sat (Be specific) Wed Sun How many hours can you work weekly? Can you work nights? Employment desired FULL-TIME ONLY PART-TIME ONLY FULL- OR PART-TIME When available for work? How were you referred to us? ___________________________________________________________________________ TYPE OF SCHOOL NAME OF SCHOOL LOCATION NUMBER OF YEARS MAJOR & (City and State) COMPLETED DEGREE High School College Bus. or Trade School Professional School HAVE YOU EVER BEEN CONVICTED OF AN OFFENSE AGAINST THE LAW OTHER THAN A MINOR TRAFFIC VIOLATION? No Yes If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation. ___________________________________________________________________________________________________
KINETIC MINDS, INC. APPLICATION FOR EMPLOYMENT APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS DATE Name Last First Middle Maiden Present address Number Street City State Zip How long Social Security No. _______ – _____ – _________ Home phone ( ) ___ Date of Birth _________________________ Cell phone ( ) ___ If under 18, please list age _____________ Email Address ___________________ Position applied for (1) and salary desired (2) (Be specific) Days/hours available to work No Pref Thur Mon Fri Tue Sat Wed Sun How many hours can you work weekly? Can you work nights? Employment desired FULL-TIME ONLY PART-TIME ONLY FULL- OR PART-TIME When available for work? How were you referred to us? ___________________________________________________________________________ TYPE OF SCHOOL NAME OF SCHOOL LOCATION (City and State) NUMBER OF YEARS COMPLETED MAJOR & DEGREE High School College Bus. or Trade School Professional School HAVE YOU EVER BEEN CONVICTED OF AN OFFENSE AGAINST THE LAW OTHER THAN A MINOR TRAFFIC VIOLATION? No Yes If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation. ____________________ ___________________________________________________________________________________________________