APPLICATION FOR EMPLOYMENT THIS APPLICATION WILL REMAIN ACTIVE FOR 90 DAYS FROM THE DATE OF APPLICATION

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1 APPLICATION FOR EMPLOYMENT THIS APPLICATION WILL REMAIN ACTIVE FOR 90 DAYS FROM THE DATE OF APPLICATION Applicants are considered for all positions without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity or expression, marital status, veteran status, disability, or other classification protected by applicable law. Date: Name: Last First Middle Address: Number Street City State Zip Code Phone No.:( ) address: Are you a United States citizen or otherwise authorized to work in the United States on an unrestricted basis? Yes No State age if under 18: Are you presently employed? Are you still a student? If so, may we contact your present employer? Position(s) applied for: Are you on a lay-off and subject to recall? Yes No Can you travel if a job requires it? Yes No Would you work?: Regular Full-Time Regular Part-Time Temporary Full-Time Temporary Part-Time Summer How did you hear about Sunrise Children s Foundation? SCF Website Nevada Job Connect Friend / Family Member Job Board Posting (Monster, Good Will, etc.) Social Media (Facebook, LinkedIn, etc.) SCF Employee Referral Word of Mouth Other Specify days and hours available: Were you previously employed by Sunrise Children s Foundation?: If yes, when? Have you ever applied for a position with Sunrise Children s Foundation? If yes, when? If you are offered a job, on what date will you be available for work? List friends or relatives presently working for Sunrise Children s Foundation: Page 1 of 6

2 REFERENCES Give name, address and phone number of three references not related to you: 1) 2) 3) Are you able to perform the essential functions of the job for which you are applying, with or without an accommodation? Yes No If an accommodation is necessary, please state the accommodation needed: Have you ever been convicted of a crime or felony which has not been annulled or sealed by a Court? Yes No If YES, explain in full, indicating date, charge, place, under what name and action taken. Use additional paper if necessary. PLEASE NOTE: In case of conviction, a careful and thorough investigation will be made. Consideration will be given to the amount of time since the conviction, your employment history, the relationship between the type of employment considered for and the crime involved and any other circumstances or information that would pertain to your employment and the safe and efficient operation of the business. Failure to answer this question truthfully may result in the denial or termination of employment. EXPLAIN: Do you have a valid driver s license? No Driver s License #: Yes Issuing State: Expiration Date: Page 2 of 6

3 EMPLOYMENT EXPERIENCE List each job held. Start with your present or last job. Include military service assignments, including the particular branch you have served in, and volunteer activities. (You may exclude groups which indicate race, color, religion, sex, national origin, age, marital status, veteran status, or disability, or other classification protected by applicable law). Note: a dishonorable or general discharge from military service is not an absolute bar to employment, and other factors will affect a final hiring decision. EMPLOYER DATES WORK PERFORMED FROM TO ADDRESS & TELEPHONE HOURLY RATE / SALARY JOB TITLE STARTING ENDING SUPERVISOR S NAME REASON FOR LEAVING EMPLOYER DATES WORK PERFORMED FROM TO ADDRESS & TELEPHONE HOURLY RATE / SALARY JOB TITLE STARTING ENDING SUPERVISOR S NAME REASON FOR LEAVING EMPLOYER DATES WORK PERFORMED FROM TO ADDRESS & TELEPHONE HOURLY RATE / SALARY JOB TITLE STARTING ENDING SUPERVISOR S NAME REASON FOR LEAVING Summarize Special Skills and Qualifications Acquired from Employment or Other Experience: Page 3 of 6

4 RECORD OF EDUCATION SCHOOL NAME ADDRESS COURSE OF STUDY HIGH CHECK LAST YEAR COMPLETED LIST DEGREE COLLEGE OTHER (SPECIFY) HONORS RECEIVED: DO YOU HAVE A VALID AND CURRENT CDA? YES NO If Yes, what type? (CHECK all that apply) Infant/Toddler Pre K Home Visiting Expiration Date: AGREEMENT I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I also agree to permit Sunrise Children s Foundation to conduct substance abuse tests and any other background investigative procedures it deems appropriate with respect to my application and, in the event of hire, while employed. In the event of employment, I understand that false, incomplete or misleading information given in my application or interview(s) may result in discharge. I also understand and agree that employment may be subject to my taking a physical examination from the Sunrise Children s Foundation physician, and that in his/her opinion I must be physically and mentally able to perform the work for which I am applying or being considered, with or without reasonable accommodation. I understand, also, that I am required to abide by all rules and regulations of Sunrise Children s Foundation. If I am employed, in consideration thereof, I agree to conform to the rules and regulations of Sunrise Children s Foundation and I recognize, understand and agree that my employment and compensation can be terminated with or without cause and with or without notice, at any time, at the option of Sunrise Children s Foundation. I understand that no one other than the Executive Director of Sunrise Children s Foundation has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing and that any such agreement must be in writing and signed by the Executive Director of Sunrise Children s Foundation. Signature of Applicant Date Submit completed applications to Human Resources at 2795 E. Desert Inn Rd. #100, Las Vegas NV 89121, via Fax (702) or hr@sunrisechildren.org THIS APPLICATION WILL REMAIN ACTIVE FOR 90 DAYS FROM THE DATE OF APPLICATION. Page 4 of 6

5 CONSENT TO DRUG AND ALCOHOL TESTING I understand that as a condition of my employment with the Sunrise Children s Foundation I will be required to complete and pass a test for the presence of illegal drugs and/or alcohol prior to the commencement of my employment. I further understand that as a condition of my employment with the Sunrise Children s Foundation I may be required to complete and pass a test for the presence of illegal drugs and/or alcohol during the course of my employment if I sustain any on-the-job injury during my employment and/or if the Sunrise Children s Foundation has a reasonable suspicion that I am in the possession of and/or have used or am under the influence, or impaired by, alcohol or controlled substances. I further understand that the term reasonable suspicion is defined in the Sunrise Children s Foundation s Employee Handbook. I hereby consent to the taking of blood, urine and/or breath samples for the purpose of alcohol and drug testing. I understand that the drug screening involves giving a sample of my blood or urine to a qualified laboratory for testing. I hereby authorize the release of the results of any such testing to the Sunrise Children s Foundation. I understand that the hospital or qualified laboratory where the test is conducted is a collection site only and I agree to hold harmless the Sunrise Children s Foundation and the hospital from any injury or other cause of action or claim arising out of the Sunrise Children s Foundation s drug testing program. DATE: Applicant/Employee s Signature Applicant/Employee s Printed Name Page 5 of 6

6 CONSUMER REPORT / CRIMINAL BACKGROUND CHECK AUTHORIZATION REQUIRED This is to inform you that, as part of our procedure for evaluating applicants for employment, a copy of a consumer report prepared by a consumer reporting agency may be obtained as part of a routine background check. The consumer report may include a criminal background check and/or credit check. In addition, this notice is to inform you that, if you are employed by Sunrise Children s Foundation, Sunrise Children s Foundation may obtain consumer reports during the course of your employment as part of our procedure for evaluating employees for promotion, reassignment or retention. Information from a consumer report will not be used in violation of any federal or state equal opportunity law or regulation. Before taking any adverse employment action based in whole or in part on the report, including denying employment, promotion, reassignment or retention, Sunrise Children s Foundation will provide to you, without charge, a copy of the report plus a written summary of your rights as a consumer under the Fair Credit Reporting Act. Signing this form constitutes written authorization by you to Sunrise Children s Foundation to seek a consumer report from a consumer reporting agency for the purpose of employment, and to seek a consumer report from a consumer reporting agency during the course of your employment for the purposes of promotion, reassignment or retention. I acknowledge that I have received a copy of the above notice, and that I authorize a copy of my consumer report to be released to Sunrise Children s Foundation both now and during the course of my employment. Signature of Applicant or Employee Printed Name of Applicant or Employee Date Page 6 of 6

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