Name *

First Name

Last Name

Phone *

(###)

###

####

Gender *

Male

Female

What services are you interested in? *

Teaching K - 3rd

Substitute

Admin

Physical Education

Does your legal status allow you to be employed in the US? *

Proof of immigration status or U.S. Citizenship will be required upon employment.

YES

NO

Are you currently employed? *

If YES, please complete the supporting reference information below.

YES

NO

Primary Reference Name

First Name

Last Name

Reference Phone Number

(###)

###

####

When will you be able to start work? *

MM

DD

YYYY

Do you have a DPS fingerprint clearance card? *

YES

NO

Expiry Date; If you have a DPS fingerprint clearance card.

MM

DD

YYYY

Do you have a CPR/First Aid card? *

YES

NO

Expiry Date; If you have a CPR/First Aid card.

MM

DD

YYYY

Statement of Understanding *

I understand that the information provided in this application is true and complete to the best of my knowledge. I understand that any misrepresentation or omission of facts may be cause for rejection of this application or termination of employment if hired. I authorize Brighter Minds Learning Center to verify the information provided in this application, including contacting my previous employers and references. I understand that this application is NOT a contract of employment.

I AGREE

I give my consent to undergo a background check as part of the hiring process. *

I CONSENT