Kickstart Kids Employee Application

Our company is an equal opportunity employer and will consider all applicants for all positions equally without regard to their race, color, sex, age, religion, national origin, citizenship, genetic information, veteran status, disability or any other classification or characteristic protected by law.

This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Each question must be answered in a complete and accurate manner as no action can be taken on this application until all questions have been answered.

If a question is not-applicable, place “NA” for that question.

Personal Information

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* 1. Name

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* 2. Date

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* 3. Home phone

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* 4. Other Phone

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* 5. Fax

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* 6. Email address

Address Information

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* 7. Current address

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

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* 8. Number of years at current address

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* 9. Previous address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

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* 10. Number of years at previous address

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* 11. Are you over 21?

Yes

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* 12. Please indicate if you are authorized to work in the United States.

Yes

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* 13. Have you ever been convicted of any crime?

Yes

If yes, state the offense, location, date, and disposition. Note: A conviction will not necessarily disqualify you from employment.

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* 14. Do you have the ability, with or without reasonable accommodations, to work overtime or to travel if travel and/or overtime are required by the job for which you are applying?

Yes

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* 15. Would you be willing and able to relocate?

Yes

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* 16. Do you have a Driver’s License?

Yes

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* 17. Driver's license

State

Number

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* 18. Is your driver's license valid?

Yes

Employment Desired

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* 19. Are you seeking

Full-Time

Part-Time

Temporary or Summer Employment

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* 20. Which area are you interested in?

North Texas (Dallas Area)

Central Texas (Austin Area)

Southeast Texas (Houston Area)

Brazos Valley

West Texas

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* 21. Position applied for

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* 22. Annual salary desired

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* 23. Date available to start

Date

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* 24. Have you ever APPLIED with our company?

Yes

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* 25. Have you ever WORKED for our company?

Yes

If you answered “yes” to either question above, state when and where you applied and/or worked.

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* 26. Are you now, or expect to be, working in any other business or job?

Yes

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* 27. Are there any days or hours you would be unable or unwilling to work?

Yes

If yes, please specify those days or hours you would be unable or unwilling to work.

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* 28. How did you hear about this job opening?

Kickstart Kids website

Kickstart Kids social media

Job search site

Friends / family

Other (please specify)

Education

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* 29. High school

School name

Address

Years attended

Major courses

Did you graduate?

What degree

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* 30. College

School name

Address

Years attended

Major courses

Did you graduate?

What degree

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* 31. Trade school

School name

Address

Years attended

Major courses

Did you graduate?

What degree

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* 32. Are you planning to pursue further studies?

Yes

If yes, when, where, and what courses?

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* 33. List any scholastic honors, offices held, and activities involved in during high school and college.

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* 34. List and describe any other school or specialized training

Military

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* 35. Have you ever served in the military?

Yes

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* 36. Service branch

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* 37. Type of discharge

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* 38. Date separated

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* 39. Final rank

Capability / Reliability

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* 40. Would you be willing and able to perform all of the tasks required by the job you are applying for?

Yes

If no, explain which tasks:

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* 41. Will you abide by the safety rules of this company?

Yes

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* 42. Have you ever been disciplined for violating company safety rules and/or regulations?

Yes

If yes, please explain:

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* 43. How many days of work (or school) have you missed in the last two years?

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* 44. How many times have you been late to work (or school) in the last two years?

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* 45. Would you be willing and able to report to work on time every day on a regular and consistent basis?

Yes

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* 46. Are you CPR/AED certified?

Yes

Work History

List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. You may use a separate sheet.

Please give month and year and do not reference your resume.

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* 47. Employment 1

Name of employer

Address

Phone

Supervisor

Started

Ended

Annual salary

Reason for leaving

Duties

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* 48. Employment 2

Name of employer

Address

Phone

Supervisor

Started

Ended

Annual salary

Reason for leaving

Duties

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* 49. Employment 3

Name of employer

Address

Phone

Supervisor

Started

Ended

Annual salary

Reason for leaving

Duties

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* 50. Employment 4

Name of employer

Address

Phone

Supervisor

Started

Ended

Annual salary

Reason for leaving

Duties

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* 51. If you worked in any of your previous positions under another name, please provide that name below. (For references purposes only.)

Name

Company

Name

Company

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* 52. Are you currently employed?

Yes

If yes, may we contact your employer?

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* 53. Have you ever been fired or asked to resign?

Yes

If yes, please explain:

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* 54. Have you ever been disciplined or received verbal or written warnings for absenteeism or tardiness?

Yes

If yes, please explain:

Martial Arts Background

List all martial arts styles you have studied and hold a ranking in.

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* 55. Style 1

Style

Rank held

School name

Phone number

Instructor / Instructors

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* 56. Style 2

Style

Rank held

School name

Phone number

Instructor / Instructors

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* 57. Style 3

Style

Rank held

School name

Phone number

Instructor / Instructors

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* 58. Style 4

Style

Rank held

School name

Phone number

Instructor / Instructors

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* 59. Have you ever taught a seminar? If yes, please complete below:

Yes

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* 60. Seminar 1

Subject

Number of students in attendance

Location

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* 61. Seminar 2

Subject

Number of students in attendance

Location

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* 62. Do you or have you ever, owned a school/studio? If yes, please complete below:

Yes

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* 63. Owned School

Name

Date opened

Date closed

Address

Phone

Reason for closing or selling

Age group of students

Current owner

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* 64. Do you or have you ever taught or managed a school/studio? If yes, please complete below:

Yes

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* 65. Managed / Taught School 1

School name

Date from

Date to

Address

Phone

Reason for leaving

Age group of students

Current owner/manager

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* 66. Managed / Taught School 2

School name

Date from

Date to

Address

Phone

Reason for leaving

Age group of students

Current owner/manager

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* 67. Please list your goals as a martial artist.

References

Give three or more references that have known you for three or more years. Do not use relatives or former employers.

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* 68. Reference 1

Name *

Company

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 69. Reference 2

Name *

Company

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 70. Reference 3

Name *

Company

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 71. Reference 4

Name

Company

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Certification

I certify that my answers to the foregoing questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am
employed, any false, misleading or otherwise incorrect statements made on this application form or during any interviews may be grounds for my immediate discharge.

I hereby authorize KICKSTART KIDS to contact any company or individual it deems appropriate to investigate my employment history, character and qualifications and

I give my full and complete consent to their revealing any and all information they wish as a result of this investigation. In addition, I hereby waive my right to bring any cause of action against these individuals for defamation, invasion of privacy or any other reason because of their statements.

I agree that, if I am employed, I will abide by all the rules and regulations of KICKSTART KIDS. I understand that the taking of drug and alcohol tests when given pursuant to company policy, are a condition of continued employment and refusal to take such tests when asked will be grounds for my immediate termination. I further understand that nobody in KICKSTART KIDS is authorized to enter into any written or verbal employment contracts with me for any definite period of time without the express written consent of the Executive Director of KICKSTART KIDS. I further understand that, if I am hired by KICKSTART KIDS, my employment will be terminable at will, that either KICKSTART KIDS or I may terminate the employment relationship at any time, for any reason and without advance notice, and that the at-will relationship can be changed only pursuant to a written agreement signed by the Executive Director of KICKSTART KIDS.