KCAA Emp App Rev 1.12 D2

KCAAPreschoolsofHawai'i

2707SouthKingSt.Honolulu,HI96826Ph:(808)941-9414Fax:(808)946-1468

APPLICATIONFOR EMPLOYMENT

POSITIONFORWHICHYOUAREAPPLYING:

In-HouseSubstitute/Floater

DATE:

Checkthe locationsat whichyou arewillingtowork:All SchoolsHawaiiKai Kahala Kailua Kakaako Kalihi Kapalama Moiliili MainOffice

Name

(Last)(First)(Middle)

Address

(Street)(City)(State)(Zip)

PhoneNo.

CellularNo.

E-mailAddress

AlternatePhoneNo.

EDUCATION/TRAINING

DidyougraduatefromHighSchool?YesNo

NameofSchool

Location

(City)(State)

NAMELOCATIONOFSCHOOL / MAJOR / DIDYOUGRADUATE
College/University / Yes / DEGREE / DIPLOMA
No / #OF UNITS COMPLETED
College/University / Yes / DEGREE / DIPLOMA
No / #OF UNITS COMPLETED
OtherTraining/Education / Yes / DEGREE / DIPLOMA
No / #OF UNITS COMPLETED

STUDENTAND/ORINTERNTEACHINGEXPERIENCE

FROM / TO / SCHOOLNAME
ADDRESS / NAMEOFPRINCIPAL/HEADTEACHER / SEMESTERHOURS

Describeanyspecializedtraining,skills,activities,qualificationsormembershipinprofessionalorganizationsthatwouldenhanceyourworkwithKCAA.

EMPLOYMENTRECORD

LISTCURRENTORMOSTRECENTEMPLOYERFIRST.Specifyallemploymentandincludeself-employment,temporary,part-timejobsandvolunteerwork.Pleaseattachadditionalsheetsifnecessary,followingthesameformat.

EMPLOYERNAMEADDRESS / DATESOFEMPLOYMENT / WORKPERFORMED
(Ifwithchildren,specifyagegroup.)
CompanyName: / FromMo./Yr. / ToMo./Yr.
Address:
PhoneNo.:
SupervisorNameJobTitle: / HourlyWage/MonthlySalary
Lastpositionheld: / Starting:Ending:
Reasonforleaving:
CompanyName: / FromMo./Yr. / ToMo./Yr.
Address:
PhoneNo.:
SupervisorNameJobTitle: / HourlyWage/MonthlySalary
Lastpositionheld: / Starting:Ending:
Reasonforleaving:
CompanyName: / FromMo./Yr. / ToMo./Yr.
Address:
PhoneNo.:
SupervisorNameJobTitle: / HourlyWage/MonthlySalary
Lastpositionheld: / Starting:Ending:
Reasonforleaving:
CompanyName: / FromMo./Yr. / ToMo./Yr.
Address:
PhoneNo.:
SupervisorNameJobTitle: / HourlyWage/MonthlySalary
Lastpositionheld: / Starting:Ending:
Reasonforleaving:

REFERENCES

Pleaselistthreereferenceswhoarenotrelatedtoyou:2Professionaland1Personal.

NAME / ADDRESS / OCCUPATION / PHONE# / RELATIONSHIP

PERSONALINFORMATION

●HowwereyoureferredtoKCAA?

●DoyouhavefriendsorrelativeswhoareorhavebeenemployedwithKCAA?YesNo

Ifyes,who?

●HaveyouappliedforajobwithKCAAbefore?YesNoIfyes,when?

●HaveyoupreviouslyworkedatKCAA?YesNoIfyes,when?

●Whatdaysandhoursareyouavailabletowork? Full-time Part-time

●Whatisyourdesiredwage/salaryforthepositionforwhichyouareapplying?

●Ifhired,onwhatdatecanyoubeginwork?

●AreyoulegallyauthorizedtoworkintheUnitedStates?YesNo

Note:Ifoffered employment, youwillberequiredtosubmittheImmigrationandNaturalizationFormI-9asrequiredbythe1986ImmigrationReformandControlAct.

●Youarenotrequiredtodiscloseinformationaboutphysicalormentallimitationsthatyoubelievewillnotinterferewithyourjobperformance.However,ifyouwantKCAAtoconsiderspecialarrangementstoaccommodateaphysicalormentalimpairment,youmaysuggestthekindofaccommodationthatyoubelievewouldbeappropriateforconsiderationbyKCAAinthespacebelow.

(Note:Ifyouhavebeenprovidedajobdescriptionofthepositionforwhichyouareapplying,pleasereviewthejobdescriptioncarefullytodeterminewhetheryouareabletoperformtheessentialjobfunctions,withorwithoutreasonableaccommodation,andmakeyourvoluntarydisclosureaccordingly.)

CERTIFICATION

PLEASEREADCAREFULLYBEFORESIGNING:

A.Icertifythattheinformationcontainedinthisapplicationsubmittedonthedatenotedbelowistrueandcorrecttothebestofmyknowledge,andunderstandthatanyfalseormisleadingstatementsormaterialomissions,wheneverdiscovered,regardingthisapplicationmayresultindisqualificationfromfurtherconsiderationorfordismissalfromemployment.

B.IfemployedbyKCAAPreschoolsofHawaii(“KCAA”),IAGREETOCONFORMTOKCAA’SGUIDELINESANDPOLICIESANDUNDERSTANDTHATMYEMPLOYMENTISAT-WILLANDCANBETERMINATEDATANYTIMEANDFORANYREASONBYTHEORGANIZATIONORMYSELFWITHORWITHOUTADVANCENOTICE.IfemployedbyKCAAundertermsofacollectivebargainingagreement,theabovestatementwillnotapply.

C.IunderstandandagreethatonlythePresidentofKCAAorherrepresentativehasanyauthoritytoenterintoanyagreementtoemploymeforanyspecifiedperiodoftimeortomodifytermsandconditionsofmyemployment.

D.IunderstandandagreethatImayberequiredtosubmittodrugtestingandacompletepost-offer,pre-employmentmedicalexaminationaspartofmyapplicationforemployment.Iunderstandthatthecostforthesepre-employmentmedicalclearanceswillbeatmyownexpense.

I alsounderstandandagreethatImay berequiredtosubmittoacompletemedicalexaminationduringmyemploymentwithKCAA,providedthatsuchexaminationisjob-relatedandconsistentwithbusinessnecessity.ThecostofsuchexaminationwillbepaidbyKCAA.

IauthorizethephysicianconductingtheexaminationandanylaboratorytestinganyspecimenobtainedbythephysicianorcollectionsitetodisclosetheresultsoftheexaminationandthelaboratorytesttoKCAAinaccordancewith state and/or federal laws.KCAAwill keepsuch resultsconfidentialanddisclosetheresultsonly topersonswhoneedtoknoworwhererequiredbylaw.IalsoagreetofullycooperateandprovideKCAAwithanyadditionalconsent(s)and/orrelease(s)asrequiredbyKCAAtoinvestigatemyemploymentapplication.

E.IunderstandandagreethatifofferedemploymentbyKCAA,Imayberequiredtodisclosecriminalconvictioninformationinaccordancewithlaw,andthatanysuchemploymentoffershallbeconditionaluponthereceiptofasatisfactorycriminalconvictionrecordasdeterminedbyKCAA.

Note:CriminalHistory(fingerprinting)clearancewillberequiredforjobsinvolvingcontactwithyoungchildreninthepreschools.

F.AlthoughKCAAmakeseveryefforttoaccommodateindividualpreferences,businessneedsmayattimesmakethefollowingconditionsmandatory:overtime,shiftwork,rotatingworkschedule,oraworkscheduleotherthanMondaythroughFriday.Iunderstandandaccepttheseasconditionsofmyemployment.

G.IherebyconsenttoandauthorizeKCAAtousemyphotographormylikenessforpublicationinprintedmedia,ontelevision,oninternetmediasuchasKCAA'swebsiteorFacebookpage,and/orinanyothermediafornootherpayorreimbursement.

YesNo

H.IunderstandandagreethatalltheforegoingtermsandconditionswillbecomepartofmyemploymentrelationshipwithKCAAifIamemployedbyKCAA.

AUTHORIZATION/

SIGNATUREOFAPPLICANT

DATE