Employment with The Learning Curve

“Learn to do common things uncommonly well; we must always keep in mind that anything
that helps fill the dinner pail is valuable.” GEORGE WASHINGTON CARVER

Application for Employment

Please supply us with as much information about yourself as possible. The form areas below
will expand to accommodate your information, all of which will be held in strict confidence.

If you'd prefer to download a form to fill out and mail, email, or fax in, please click here.

NAME (First, Last)

BIRTH DATE (00/00/0000)

HOME ADDRESS

CITY

STATE

ZIP

PHONE NUMBER

ALTERNATE PHONE NUMBER

EMAIL ADDRESS

SOCIAL SECURITY NUMBER

DRIVER'S LICENSE NUMBER

GENDER MALE FEMALE

EMPLOYMENT HISTORY — Begin with most recent or with current employer.

EMPLOYER NAME/ADDRESS

POSITION

DATES EMPLOYED

SUPERVISOR/PHONE

EMPLOYER NAME/ADDRESS

POSITION

DATES EMPLOYED

SUPERVISOR/PHONE

EMPLOYER NAME/ADDRESS

POSITION

DATES EMPLOYED

SUPERVISOR/PHONE

EDUCATION — Begin with the last school attended.

COLLEGE/SCHOOL & ADDRESS

DATES ATTENDED

DID YOU GRADUATE? YES NO

DEGREES RECEIVED/AREA

COLLEGE/SCHOOL & ADDRESS

DATES ATTENDED

DID YOU GRADUATE? YES NO

DEGREES RECEIVED/AREA

COLLEGE/SCHOOL & ADDRESS

DATES ATTENDED

DID YOU GRADUATE? YES NO

DEGREES RECEIVED/AREA

REFERENCES — Please list three references (not related to you) who can attest to your character and your ability to perform on a job.

NAME

ADDRESS

PHONE

OCCUPATION

NAME

ADDRESS

PHONE

OCCUPATION

NAME

ADDRESS

PHONE

OCCUPATION

ARE YOU LICENSED
TO TEACH IN MISSISSIPPI? YES NO

IN WHAT AREAS?

HAVE YOU EVER BEEN
CONVICTED OF A FELONY? YES NO

IF YES, PLEASE
STATE REASON

LIST ANY SPECIAL SKILLS THAT YOU HAVE THAT MAY RELATE TO THIS JOB

IN CASE OF EMERGENCY, PLEASE NOTIFY THIS PERSON. LIST NAME, NUMBER, AND RELATIONSHIP TO YOU.

WHEN CAN YOU BE AVAILABLE?

OUR PRIVACY POLICY IN REGARDS TO YOUR PROVIDING TO US ANY PERSONAL INFORMATION:

We recognize and appreciate the importance of the responsible use of information collected from you on this page.

We will only use the information you provide to us in order to evaluate your suitability for employment.

THE LEARNING CURVE will never release any information you provide us with to other companies or organizations.