Hearn Academy

A Ball Charter School

“Where Children Are The Priority”

Dr. Gaye Leo, Principal

17606 N. 7th Avenue * Phoenix, Arizona 85023

(602) 896-9160 * Fax (602) 896-1997

* e-mail

Employment Application

We appreciate the opportunity to review your qualifications for employment with our school. So that we can thoroughly consider your special skills and abilities, we would appreciate your completion of our employment application. Applications are only accepted for positions currently available and this application will be considered for 90 days from the date on the application or the position is filled, whichever occurs first.

If you want to be considered for employment subsequent to that date, a new application must be completed.

Hearn Academy is an equal opportunity employer and does not discriminate on

the basis of race, religion, gender, age, color, national origin, veteran status,

disability or any other basis prohibited by federal, state or local law.

Hearn Academy, like all schools, does not allow any form of tobacco use on school property. Please keep this in mind when you are applying for a position with us.

APPLICANT NAME:______Date ___/___/___

POSITION APPLYING FOR:______

EMPLOYER USE:

Score on Screening ______

Score on Paper (20 pts each piece) ______

Score on Team Interview ______

TOTAL SCORE ______

Last Name First Name M. Social Security #
Street Address City State Zip Code Home Phone #
Email address Cell Phone #
Are you at least 18 years old? / If not, state your age for child labor law purposes only
Are there any days, shifts or hours you will not work?
If yes, please explain:
When will you be able to start work?
Have you taken any illegal drugs in the last 30 days?
How did you learn about Hearn?
Have you ever applied or worked here before? / If yes, when
Are you legally authorized to work in the United States?
Will you now or in the future require sponsorship for employment visa status?
Note: The Federal Immigration and Reform and Control Act of 1986 requires that an INS Employment Eligibility Verification “Form I-9” be completed for every new hire and that within 3 business days of beginning work every new hire must present to the employer documentation establishing his/her identity and authorization to work. This federal requirement must be satisfied as a condition of employment.
Have you been convicted of a felony within the last seven years? / Date
Note: Answering “yes” does not automatically exclude you from further consideration for the position. If yes, please explain below, including the penalty imposed.
Have you been convicted within the last seven years of misappropriation of funds, embezzlement, or similar for other dishonest conduct, or an offense involving the use of a weapon, for burglary, robbery, breaking and entering or theft, of for physical assault or other violent crime? If yes, please explain below
Note: Answering “yes” does not automatically exclude you from further consideration for this position.
Have you ever been a defendant in a civil action for intentional tort (intentional commission of a wrongful act)? If yes, please explain below.
Note: Answering “yes” does not automatically exclude you from further consideration for this position.

(Insert Resume’ AND fill out next page)

Employment History:

(Please complete for all full-time or part-time employment beginning with the most recent employer)

Company Name / Phone #
Address / Employed
From: To:
City, State, Zip / Starting Pay
Last Pay
Name of Supervisor / Their Title
Their e-mail address /
Their Phone#
Job Title and Describe duties / Reason for leaving
Company Name / Phone #
Address / Employed
From: To:
City, State, Zip / Starting Pay
Last Pay
Name of Supervisor / Their Title
Their e-mail address /
Their Phone#
Job Title and Describe duties / Reason for leaving
Company Name / Phone #
Address / Employed
From: To:
City, State, Zip / Starting Pay
Last Pay
Name of Supervisor / Their Title
Their e-mail address /
Their Phone#
Job Title and Describe duties / Reason for leaving
Company Name / Phone #
Address / Employed
From: To:
City, State, Zip / Starting Pay
Last Pay
Name of Supervisor / Their Title
Their e-mail address /
Their Phone#
Job Title and Describe duties / Reason for leaving

Driving Record: (Answer only if driving is a requirement of the job for which you are applying)

Do you have a valid driver’s license? / State / License #
Have you had any tickets? If yes, please explain
Has your license been suspended or revoked? If yes, please explain
Do you have any DUI or DWI Convictions? If yes, please state
when and where you were convicted

Residences: (Please provide your addresses of residence for the past seven years beginning with the most recent address)

Street Address / City / State / Zip / From / To
Street Address / City / State / Zip / From / To
Street Address / City / State / Zip / From / To
Street Address / City / State / Zip / From / To
Street Address / City / State / Zip / From / To
Street Address / City / State / Zip / From / To

Education: (May or may not be considered depending on job applied for)

School Name

/ Dates Attended / Graduate? / Year
Please explain any gaps in your employment history
Have you ever been discharged or forced to resign? If yes, explain
Have you ever been suspended or placed on administrative leave?
If yes, explain
Were you given a performance evaluation within the last 12 months of active employment?
If yes, what was your score?
Have you signed any non-compete or non-solicit agreement with any other employer that might restrict you from working for us?
If yes, please explain
Do you have a valid AZ Class I
Fingerprint Card? / Exp
Date / Card #
What is your salary requirement?
How many hours/week do you need?

Military: (Complete only if you served in the military)

Branch of Service / From / To / Discharge Date / Rank at discharge
Reason for leaving
Describe any military skills, training or experience you believe are relevant to the job applied for

Professional References:

Name / Title / Known for / Phone# / E-mail address

Representations of Employee:

Hearn Academy has relied on the information presented to it by the Employee in the Employee’s resume, application and other documents submitted by the Employee. Any falsehood or misrepresentation shall constitute grounds for immediate termination of this employment relationship. Employee has affirmatively represented that he/she has not been charged or convicted of a dangerous crime, including child molestation, against children as defined in the Arizona Statutes. Employee agrees to immediately report to the School’s administration, the arrest, submission of a “no-contest” plea, or conviction of any crime during the period of employment. Applicant also agrees to a background, reference and/or credit check conducted by Hearn Academy. These findings will be used as part of the hiring decision.

______/_____/_____

SignatureDate