Personal Information:









Employment Interest:





Are you available to work the following:


YesNo

YesNo

YesNo

YesNo

General Information:


YesNo

Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.


YesNo

Note: We are required to obtain a work permit from all employees under age 18 before they begin work. Generally, work permits are issued at the school the minor is attending. If you are under 18 and do not currently have a work permit, please contact your school.



YesNo


YesNo


YesNo


YesNo

Employment History:

Starting with your most recent employment, list employment for the past 10 years including self-employment, summer, part-time, and part or full-time military service. You may include any work performed on a volunteer basis.

Employer 1















Employer 2















Employer 3















Employer 4















Employer 5















Education



YesNo

High School



YesNo


College or Technical School



YesNo


Graduate School



YesNo




References

List three Supervisory references you have known over three years who are not related to you.

Reference 1





Reference 2





Reference 3





Notice to all applicants:

Employment with KH may be contingent upon the applicant passing a reference check, background check and/or physical. KH has the right to revoke any offer of employment based on the failure of a failed reference, failed background check and or failed physical.

KH is authorized to investigate all statements made on the application and to discuss the results of its investigations with those responsible for hiring. KH may also contact my former employer(s) or other persons who can verify information.

I have read and agree to the conditions stated above. I give my consent to former employer(s) and other contact persons to respond to questions pertaining to information on this application. Further I release from liability such former employer(s) or other persons contacted by and providing information to KH I acknowledge that all the above statements are true. Falsification on an employment application is grounds for immediate termination.