Little Miss Mag Employment Application

PERSONAL INFORMATION
Name *
Name
Address *
Address
Birth Date *
Birth Date
Emergency Contact *
Emergency Contact
AVAILIBILITY
Date Available *
Date Available
Please list days and hours available, Monday through Friday.
Employment History
List most recent job first.
Place Position/Job Dates Reason for Leaving
Place Position/Job Dates Reason for Leaving
Place Position/Job Dates Reason for Leaving
References
List at least 3 references including former employers.
Name Title Phone Number Time Known
Name Title Phone Number Time Known
Name Title Phone Number Time Known
Education and Experience
List diplomas, degrees, and certifications. Title School/Institution Address Dates
List all training attended including workshops, conferences, and courses. Title Place Date Hours
Place Purpose/Job Dates Contact Person
Have you ever been arrested or convicted of any law violations? *
TCA 14-10-129 states that "each person applying to work with children as a volunteer or as a paid employee...shall complete an application on a form prescribed or approved by the Department of Human Services...It shall be unlawful for any person to falsify any information required on the application. Knowingly failing to disclose required information shall be deemed to be a falsification to the same extent as providing false information. By electronic signing this form, I am affirming that the above statements I have made are true and factual to the best of my knowledge. I am granting permission for all persons, organizations, or agencies listed above to be contacted for the expressed purpose of pre-employment screening.
Date *
Date

Equal Employment Opportunity

Little Miss Mag provides equal opportunity to all applicants for employment and existing personnel and administers all personnel practices, such as recruitment, hiring, promotions, and all other terms, conditions, and privileges of employment, in a manner which does not discriminate on the basis of race, color, religion, national origin, gender, age, disability or any other basis prohibited by law.