PERSONAL INFORMATION
FULL NAME: ___________________________________ DATE: __________________
First Middle Last
ADDRESS: _____________________________________________________________
Street Address Apt/Suite
_____________________________________________________________
City State Zip Code
E-MAIL: __________________________________ PHONE: _____________________
POSITION(S) APPLIED FOR: _______________________________________________
____________________________________________________________________________
EMPLOYMENT ELIGIBILITY
ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S? ☐ YES ☐ NO*
*IF NO, PLEASE EXPLAIN: _____________________________________________________
____________________________________________________________________________
HAVE YOU EVER BEEN DISMISSED FROM A POSITION? ☐ YES* ☐ NO
*IF YES, PLEASE EXPLAIN: ____________________________________________________
____________________________________________________________________________
ARE YOU CURRENTLY SERVING A SUSPENSION FROM A TAPPS OR NON-TAPS
SCHOOL? ☐ YES* ☐ NO
*IF YES, PLEASE EXPLAIN: ____________________________________________________
____________________________________________________________________________
HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR? ☐ YES* ☐ NO
*IF YES, PLEASE EXPLAIN: ____________________________________________________
____________________________________________________________________________
BACKGROUND CHECK CONSENT
ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK? ☐ YES ☐ NO
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