WKU
High School Liberty Employment Application An Equal Opportunity Employer
High School Liberty Employment prohibits discrimination in employment because of race, color, sec, religion, age, national origin, disability, citizenship status, sexual orientation, sexual identify, participation in military service or any other unlawful basis in accordance with all applicable federal and state laws.
As part of the hiring process, your application information, your personal references, and most recent employment information may be verified. If you have misrepresented or omitted any facts on this application, and are hired, you may be terminated from your position.
This application must be completed in its entirity. Incomplete applications will not be accepted or considered. Required fields are noted with an asterisk (*).
If hired, you may be required to: supply a birth certificate or other proof of authorization to work in the US, have a physical examination and/or drug test, sign a conflict of interest document, or sign an intellectual property agreement.
Personal Information
* Indicates a required field.
*Name
First
Middle
Last
*Daytime Phone Number
###
-
###
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####
*Address
Street Address
City
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
State
Postal / Zip Code
Social Security Number (Please do not fill this information in, but know that you'll be asked to provide it on an application.)
*Are you legally eligible to work in the US?
Yes
No
Please choose one.
Position Desired
* Indicates a required field.
*What type of employment do you want?
Full Time
Part Time
Please choose one.
*What are the two (2) most important reasons this job appeals to you?
1.
2.
*What are your wage expectations per hour?
*List the skills you have that make you qualified for this position
Work Schedule
What is the fewest number of hours you would consider acceptable?
Per Week
Per Day
Can you work a flexible schedule? (Days and number of hours scheduled can vary from week to week)
Yes
No
What hours are you available to work?
Sunday:
00:00 AM
00:30 AM
01:00 AM
01:30 AM
02:00 AM
02:30 AM
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From
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To
Monday:
00:00 AM
00:30 AM
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From
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To
Tuesday:
00:00 AM
00:30 AM
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From
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11:00 PM
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To
Wednesday:
00:00 AM
00:30 AM
01:00 AM
01:30 AM
02:00 AM
02:30 AM
03:00 AM
03:30 AM
04:00 AM
04:30 AM
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From
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01:00 AM
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02:30 AM
03:00 AM
03:30 AM
04:00 AM
04:30 AM
05:00 AM
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To
Thrusday:
00:00 AM
00:30 AM
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04:00 AM
04:30 AM
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From
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00:30 AM
01:00 AM
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03:00 AM
03:30 AM
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11:00 PM
11:30 PM
To
Friday:
00:00 AM
00:30 AM
01:00 AM
01:30 AM
02:00 AM
02:30 AM
03:00 AM
03:30 AM
04:00 AM
04:30 AM
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From
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00:30 AM
01:00 AM
01:30 AM
02:00 AM
02:30 AM
03:00 AM
03:30 AM
04:00 AM
04:30 AM
05:00 AM
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11:00 PM
11:30 PM
To
Saturday:
00:00 AM
00:30 AM
01:00 AM
01:30 AM
02:00 AM
02:30 AM
03:00 AM
03:30 AM
04:00 AM
04:30 AM
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06:00 AM
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12:00 PM
12:30 PM
01:00 PM
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07:00 PM
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08:00 PM
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10:00 PM
10:30 PM
11:00 PM
11:30 PM
From
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00:30 AM
01:00 AM
01:30 AM
02:00 AM
02:30 AM
03:00 AM
03:30 AM
04:00 AM
04:30 AM
05:00 AM
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11:00 PM
11:30 PM
To
Other Information
* Indicates a required field.
*Do you have any tattoos on visible parts of your body that might show while you're at work?
Yes
No
Please choose one.
If yes, are you willing to cover them up while at work?
*Do you have a nose piercing, tongue piercing, eyebrow piercing, or large gauged ears?
Yes
No
Please choose one.
If yes, would you be willing to cover the piercings up, or take them out, while at work?
*Have you ever been convicted of a crime (other than minor traffic violations)?
Yes
No
Please choose one.
If yes, list all convictions, showing offenses and date:
*In your prior employment, have you had shortages or misunderstandings about merchandise or money?
Yes
No
Please choose one.
If yes, please fully describe:
*Have you ever been terminated from a job or asked to resign?
Yes
No
Please choose one.
If yes, please list dates and explain:
*Do you have reliable transportation?
Yes
No
Please choose one.
School Most Recently Attended
* Indicates a required field.
*Name
School Name
*Phone
###
-
###
-
####
*Address
Street Address
City
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
State
Teacher or Counselor
Grade Point Average (GPA)
Freshman
Sophomore
Junior
Senior
Last Grade Completed
*Graduated?
Yes
No
Please choose one.
If no, anticipated graduation date?
Month Year: May 2013
*Tell us about any Sport or other activities you are involved:
Most Recent Employment
Name
Company Name
Phone
###
-
###
-
####
Address
Street Address
City
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
State
Position
Supervisor
Date worked?
From
To
Describe your responsibilities and tasks:
Reason for leaving or seeking new employment:
Personal References
* Indicates a required field.
*Name
Full Name
*Phone
###
-
###
-
####
*Address
Street Address
City
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
State
*Name
Full Name
*Phone
###
-
###
-
####
*Address
Street Address
City
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
State
In Case of Emergency Notify
* Indicates a required field.
*Name
Full Name
*Daytime Phone Number
###
-
###
-
####
*Address
Street Address
City
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
State
Relationship
*In order to submit this application to your instructor, please select her/his name from the drop down menu.
Ashley Brown
Instructor Name