Human Resources Department

APPLICATION FOR EMPLOYMENT

PLEASE COMPLETE THE FOLLOWING APPLICATION IN FULL

_________________________________________ __________________________________________ __________________________________________ _____________________ LAST NAME FIRST NAME MIDDLE NAME DATE OF APPLICATION

CURRENT ADDRESS CITY STATE ZIP

( _________ ) _____________________________ ( _________ ) _____________________________ ____________________________________________________________________ PRIMARY PHONE NUMBER SECONDARY PHONE NUMBER PRIMARY EMAIL

Have you applied for a job at Heritage in the last 6 months? YES NO

REFERRAL SOURCE – please check one.

Walk-in Newspaper KSL Jobs Career Fair Internship @ Heritage

Job Service Center Heritage Facebook Current Employee Referral University Job Boards

LDS Jobs Heritage Website Former Employee Referral Other:

JOB PREFERENCE / WORK AVAILABILITY

1st Choice: ___________________________________________________________________________________________

2nd Choice: __________________________________________________________________________________________

Type of Employment Desired

Full-Time Part-Time

Schedule Availability: 6:00 AM – 3:00 PM 2:30 PM – 11:00 PM 10:30 PM – 7:00 AM 8:00 AM – 5:00 PM

Date Available to Work: _______________ Minimum Salary Requirement: _______________

Are you willing to work weekends?

Yes No

*Some positions require working weekends. Inability to work Saturday and/or Sunday may disqualify you from these positions.

EDUCATION & LICENSURE

Have you graduated from high school or completed the GED equivalent? Yes No

SCHOOL NAME MAJOR DEGREE RECEIVING / RECEIVED GRADUATED? College/University

Yes No

Advanced Study Yes No

Trade/Vocational Yes No

List any professional state licensures you currently hold:

1. License #: __________________________________________ State Registered: Expiration Date:

2. License #: __________________________________________ State Registered: Expiration Date:

Do you have any pending restrictions and/or a suspension on your current license? Yes No

Have you ever been refused licensure, or had a license suspended or revoked? Yes No

If “yes” on any of the previous two questions, please explain below:

Have you ever been convicted of a crime? Yes No *Background Screenings will be completed.

If “yes,” please provide an explanation, along with the date and location of crime.

Have you ever volunteered at, completed an internship at, or have been employed by Heritage? Yes No

If yes, when? From: ______ / ______ / __________ To: ______ / ______ / __________ In what capacity?

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DO NOT WRITE IN THIS SPACE

NAME:

EMPLOYMENT HISTORY – start with current or most recent employer.

COMPANY CITY STATE ZIP

( ) May we contact this employer? YES NO PHONE SUPERVISOR

________ / ________ / ____________ ________ / ________ / ____________ DATE HIRED DATE LEFT REASON FOR LEAVING

TITLE & RESPONSIBILITIES

COMPANY CITY STATE ZIP

( ) May we contact this employer? YES NO PHONE SUPERVISOR

________ / ________ / ____________ ________ / ________ / ____________ DATE HIRED DATE LEFT REASON FOR LEAVING

TITLE & RESPONSIBILITIES

COMPANY CITY STATE ZIP

( ) May we contact this employer? YES NO PHONE SUPERVISOR

________ / ________ / ____________ ________ / ________ / ____________ DATE HIRED DATE LEFT REASON FOR LEAVING

TITLE & RESPONSIBILITIES

List any special skills or relevant experience:

REFERENCES Please list three additional references; none of which are related to you or are clergy.

NAME PHONE EMAIL

How long have you known this reference and in what capacity?

NAME PHONE EMAIL

How long have you known this reference and in what capacity?

NAME PHONE EMAIL

How long have you known this reference and in what capacity? The information in this application is complete and accurate to the best of my knowledge. Any misrepresentation or omission of the facts disqualifies me from further consideration, or, if I am employed, is sufficient cause for dismissal. I authorize investigation of all statements contained in this application and do hereby release any and all persons, companies, or agencies to release any and all information concerns my previous employment and any pertinent information that they may have, and release all parties from liability for any damage that may result from furnishing the same. I further understand that if I am employed, my employment will not be for a definite duration and can be terminated at any time by either myself or by Heritage Schools, Inc. I understand that none of the company’s personnel policies should be construed as a contract or as a guarantee of continued employment. Any employment, if offered, will be subject to the conditions of and compliance with Heritage Schools, Inc. policies and established procedures. Any employment offer is contingent upon producing documents establishing my eligibility to work in the United States, satisfactory results from reference checks, and compliance with Heritage Schools, Inc. policies and procedures. I fully agree to the foregoing terms and conditions.

It is the policy of Heritage Schools, Inc. to develop, implement, and maintain employment policies and practices that are based upon individual merit without regard to race, color, sex, age, religion, national origin, handicap, veteran, or citizenship status. In addition, it is the policy of this organization to actively promote the realization of Equal Employment Opportunity and compliance with the concepts and practices of Affirmative Action.

SIGNATURE DATE

----------------------------------------------------------------------------------------------------------------------------- ------------------------------------- The Federal Government requires employers to collect statistical information on job applicants. Providing this information is voluntary. Non-completion of the survey will not in any way affect your employment and the survey will be used for statistical purposes only. It will not be included in your application file, and will be kept confidential. Refusal to provide this information will not subject the application or employee to any adverse treatment. It will be used only in accordance with the regulations. 1. Sex: Male Female

2. Race/Ethnic Background: Check all that apply

Asian Pacific Islander American Indian/Native American Black White Hispanic

3. Disabled/Veteran Status: Check all that apply

Disabled, but not a veteran (1) Veteran of Vietnam Era (V) Disabled Veteran (D) None of the above

I do not wish to complete this survey.