Non-Professional Application for Employment
Application For:
______________________ Application Received: __________________ Available Start Date: ___________________
Graystone Academy
PO Box 72218
Thorndale, PA 19372-0218
610-383-4311
Graystone Academy is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religion, marital status, sexual orientation, political belief or disability.
Federal law prohibits the employment of unauthorized
aliens. All persons hired must submit
satisfactory proof of employment authorization and identity within three (3)
days of being hired. Failure to submit
such proof within the required time may result in immediate employment
termination.
___________________ __________________ _____________________
First Name Middle Last
___________________ __________________ _____ __________
Street Address City State Zip Code
___________________ __________________ _____________________
Home Telephone Number Social
Security Number Todayís
Date
____________________________ _____________________
Daytime Phone (contact permitted) E-Mail
Address
______________________________________________________________________________________
Other phone numbers
Have you ever been convicted
of a crime? ____ Yes ____ No
If ìyesî, please explain on
reverse side of this page or on an attachment.
For what position are you
applying? ___________________________________
Schedule desired: _______ Full Time____ Part Time____
# of Hours/Week_____
Are you available to work overtime? Yes _____ No ______
Approximate
date you can begin work? ____________ _____________________
High School
School Name:
____________________________________________________
City and State:
____________________________________________________
Diploma: ____________________________________________________
Major or Subject:
__________________________________________________
Grade Point Average:
___________
School Name:
____________________________________________________
City and State:
____________________________________________________
Degree or # of years
completed:
______________________________________
Major or Subject:
__________________________________________________
Grade Point Average:
___________
Other College/University
School Name:
____________________________________________________
City and State:
____________________________________________________
Degree or # of years
completed:
______________________________________
Major or Subject:
__________________________________________________
List any certificates earned
or in progress, and/or any additional training programs not included in your
formal education.
___________________________________________________________________________________________________________________________________________________________________________
Please list Professional Affiliations to which you belong
(please do not list activities which would indicate age, sex, color, race,
creed, national origin, religion, marital status, sexual orientation, political
belief, or disability):
________________________________________________________________
________________________________________________________________
Name Title Company Phone Professional
Relationship
____________ _______ _____________ ________ _________
____________ _______ _____________ ________ _________
____________ _______ _____________ ________ _________
____________ _______ _____________ ________ _________
List your current or most recent employment first. Include work related internships, military and volunteer work. Continue on another page as necessary.
Current Employer: ________________________________________________
City and State:
__________________________________________________
Telephone Number: _______________________
Supervisorís Name and Title: ________________________________________
Position Held/Title:
________________________________________________
Reasons for Leaving:
______________________________________________
Dates of Employment: From:
_________ To: __________
May We Contact this Employer: Yes: _____ No: _____
Previous Employer:________________________________________________
City and State:
_________________________________________________
Telephone Number: _______________________
Supervisorís Name and Title: ________________________________________
Position Held/Title:
________________________________________________
Reasons for Leaving:
______________________________________________
Dates of Employment: From:
_________ To: __________
May We Contact this Employer: Yes: _____ No: _____
Previous
Employer:________________________________________________
City and State:
_________________________________________________
Telephone Number: _______________________
Supervisorís Name and Title: ________________________________________
Position Held/Title:
________________________________________________
Reasons for Leaving:
______________________________________________
Dates of Employment: From:
_________ To: __________
May We Contact this Employer: Yes: _____ No: _____
Previous Employer:
_____________________________________________
City and State:
_________________________________________________
Telephone Number: _______________________
Supervisorís Name and Title: ________________________________________
Position Held/Title:
________________________________________________
Reasons for Leaving:
______________________________________________
Dates of Employment: From:
_________ To: __________
May We Contact this Employer: Yes: _____ No: _____
Previous Employer: _______________________________________________
City and State:
_________________________________________________
Telephone Number: _______________________
Supervisorís Name and Title: ________________________________________
Position Held/Title:
________________________________________________
Reasons for Leaving:
______________________________________________
Dates of Employment: From:
_________ To: __________
May We Contact this Employer: Yes: _____ No: _____
Your Name: _______________________________Non-Professional
Application
In connection with my application for employment and as a condition of continuing employment, I understand that investigative background inquiries may be made on me including previous employers, schools, consumer credit, criminal convictions, motor vehicle, and other reports. These reports will include information as to my character, work habits, performance, education, compensation, and experience along with reasons for termination of employment from previous employers. Furthermore, I understand that the company may be requesting information from various federal, state, and other agencies that maintain records concerning my past activities relating to my driving, credit, criminal, civil and other experiences as well as claims involving me in the files of insurance companies. I authorize without reservation, any party or agency contacted to furnish the above mentioned information and release all parties involved from liability and responsibility for doing so. I hereby consent to obtaining the above information from Graystone Academy and/or any of its agents. This authorization and consent shall be valid in original, fax, or copy form.
___________________________________________ ______________________
Signature of Applicant Date
All hiring and employment at Graystone Academy is at will. I understand this application is not an
employment contract, nor can it be used to create one. Employment by Graystone Academy has no
specific term and may be terminated by the employee or by the Graystone Academy
with or without notice. I
acknowledge that Graystone Academy has not made any promises or
representations that differ from those contained in this paragraph.
I understand I must provide satisfactory documents to establish my identity and right to work in the United States, if I am offered a position with Graystone Academy, and that failure to provide this evidence will result in the termination of my employment.
I release and hold harmless any individual, company,
business institution or government agency from all liability with regard to
furnishing information to Graystone Academy.
I agree to release and hold harmless Graystone Academy from all
liability with respect to the receipt of such information.
I certify that the information I have furnished on this
application form is true and complete.
I understand that if any misrepresentation has been made by me verbally
or in writing, any offer of employment made to me may be withdrawn or my
subsequent employment with Graystone Academy may be terminated.
__________________________________ ___________________
Signature of Applicant Date
How were you referred to Graystone Academy? Please circle the number of the most appropriate
response.
1 2 3 4 5 6
College Recruiter Employee Advertisement No Other:
________
Or or Referral;
University Agency Walk-in