EMPLOYMENT APPLICATION
PLEASE PRINT OR TYPE
Today’s Date
First Name
MI
Last Name
Preferred Name/Nickname
Street Address
Apt #
City
State
Zip Code
Home Phone
Alternate/Work Phone
Email Address
PLEASE PLACE A CHECK BY YOUR RESPONSE OR PROVIDE THE APPROPRIATE INFORMATION
Are you interested in:
Full Time
Part Time
Temporary
What schedule would you prefer?
Weekdays
Weekends
2nd Shift
Split Shift
How did you hear about the position?
Classified Ad
Friend (Name)
Radio
Internet
Desired Pay:
Hourly Pay
$
Annual Pay
$
$
(Minimum: if applicable)
Minimum
Desired
When are you able to start work?
Date:
Position desired:
PLEASE CHECK YES OR NO TO THE FOLLOWING:
Are you authorized to work in the United States?
Yes
No
Federal law requires that employers hire only individuals who are authorized to be lawfully employed in the United
States. In compliance with these laws, Champion Kidz Clubhouse will verify the status of every individual offered
employment with Champion Kidz. In this connection, all offers of employment are subject to verification of the
applicant’s identity and employment authorization, and it will be necessary for you to submit such documents as are
required by law to verify your identification and employment authorization.
Are you under 18 years of age?
Yes
No
If yes, can you furnish a work permit?
Yes
No
Are you capable of performing the essential functions of the job for
Yes
No
which you are applying with or without a reasonable accommodation?
Champion Kidz is an equal opportunity employer and does not discriminate against any applicant or employee
because of race, color, religion, sex, national origin, disability, age, or military or veteran status in accordance
with federal law. In addition, Champion Kidz complies with applicable state and local laws governing
non-discrimination in employment in every jurisdiction in which it maintains facilities. Champion Kidz also
provides reasonable accommodation to qualified individuals with disabilities in accordance with applicable laws.
