Your Name (Last Name First)

Social Security Number

Present Address

Apt #

City

State

Zip Code

Permanent Address

Apt #

City

State

Zip Code

Are you 21 years or older?
 YES NO

Phone

Email

Desired Position

Start Date

Desired Salary Range

Are you currently employed
 YES NO

If so, may we contact your present employer?
 YES NO

Have you worked for Camelot before?
 YES NO

Where?

When?

Reason for leaving

Name of last supervisor at this company

Who referred you to Camelot?
Employment AgencyNewspaper AdFriendState Employment OfficeCollege Placement ServiceWalk InOther

Are you able to perform the essential functions of the job you are applying for with or without accommodations?
 YES NO

High School
Name and location:       Did you graduate?  YES NO
Degree (if applicable):

College or University
Name and location:       Did you graduate?  YES NO
Degree (if applicable):

Graduate Study / College
Name and location:       Did you graduate?  YES NO
Degree (if applicable):

Trade, Business, or Correspondence School
Name and location:       Did you graduate?  YES NO
Degree (if applicable):

Subjects of special study or research work

Special training, licenses, certifications

Special skills

Name of present of last employer

Address

City

State

Zip

Starting date

Leaving date

Job title

Starting salary

Final salary

May we contact your supervisor
 YES NO

Name of supervisor

Title

Phone

Description of work

Reason for leaving

Previous employer

Address

City

State

Zip

Starting date

Leaving date

Job title

Starting salary

Final salary

May we contact your supervisor
 YES NO

Name of supervisor

Title

Phone

Description of work

Reason for leaving

Please provide three professional (preferably supervisors) references that you have known at least one year, individuals with whom or for whom you have worked, please do not include friends or family members.

Name

Relationship to you

Years acquainted

Phone

Name

Relationship to you

Years acquainted

Phone

Name

Relationship to you

Years acquainted

Phone

Branch of service

Discharge date

Discharge rank

Have you ever been convicted of a criminal offense other then a minor traffic violation in the last 7 years?
 YES NO

If yes, explain (will not necessarily exclude you from consideration)

Camelot Schools, is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, national origin, handicap, or engage in any other unlawful discrimination.

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give Camelot Schools, any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for damage that may result from use of such information.

I also understand and agree that no representative of Camelot Schools has any authority to enter into any agreement for employment for any specified period of time or to make agreement contrary to the foregoing unless it is in writing and signed by an authorized company representative. Employment at Camelot Schools is, at all times, strictly at-will, and employment can be terminated at any time by either party."

Full Name

Date