Energized Employee Signup

HUMAN CAPITAL DEPARTMENT

7055 Beechnut Street, Houston, Texas 77074

Office 713.394.3550

JOB APPLICATION

Energized for Excellence Academy, Inc. is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application proves, he or she should contact a company representative.

Applicant Information:

First Name*

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Middle Initial

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Last Name*

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Email 1*

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Email 2

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Work Phone

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Address*

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Street Address

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City*

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Zip/Postal*

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Home Phone*

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Mobile Phone

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Emergency Contact Name

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Emergency Contact Phone number

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Employment Information:

Position(s) Applying For*

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How did you Hear about the Position?*

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When can you start working if hired?*

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Current Salary?*

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Personal Information:

Have you ever applied to or worked for Energized for Excellence Academy, Inc. before? *

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Yes

If YES when?

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Do you have relatives, friends and/or acquaintances working for Energized for STEM Academy, Inc.?*

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Yes

If yes, state their name(s) and relationship:

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Are you over the age of 18?*

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Yes

Are you authorized to work in the United States?*

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Yes

Will you consent to a mandatory controlled substance test?

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Yes

Have you ever been convicted of a criminal offense (felony or misdemeanor)?

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Yes

If yes, please state the nature of the case, when and where convicted and disposition of the case:

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(Note: Energized for Excellence Academy, Inc. complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.)

Education:

(Note: Applicants may be required to provide proof of diploma, degree, transcripts, licenses, certifications, and registrations)

High School

School Name*

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City,State*

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Degree Earned*

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College/University

School Name 1

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City,State*

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Degree Earned*

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School Name 2*

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City,State

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Degree Earned

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Vocational School/Specialized Training

School Name

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City,State

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Degree Earned

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Military

Are you a member of the Armed Forces?

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What was your military rank when discharged?

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How many years did you serve in the military?

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Previous Employment

Employer Name

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Employer Address

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City

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Zip/Postal

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Employer Phone number

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Job Title

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Salary

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Supervisor Name

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Dates Employed

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Reason for Leaving

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Employer 2

Employer Name

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Employer Adress

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City

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Zip/Postal

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Employer Telephone

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Job Title

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Salary

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Supervisor Name

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Dates Employed

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Reason for Leaving

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Employer 3

Contact Information

Employer Name

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Employer Address

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City

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Zip/Postal

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Employer phone number

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Job title

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Salary

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Supervisor Name

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Dates Emplyed

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Reason for leaving

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References:

Please provide three personal and professional reference(s) below:

Reference Name

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Contact Information

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Reference Name

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Contact information

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Reference Name

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Contact Information

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Additional Information: Please list current certifications:

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AT-WILL EMPLOYMENT:

The relationship between you and Energized for Excellence Academy, Inc. is referred to as “employment at will.” This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or Energized for Excellence Academy, Inc. No representative of Energized for Excellence Academy, Inc. has authority to enter into any agreement contrary to the foregoing “employment at will” relationship. You understand that your employment is “at will,” and that you acknowledge that no oral or written statements or representations regarding your employment can alter your “at-will” employment status.

Energized for Excellence academy, inc

Location: 7055 Beechnut Street, Houston, Texas 77074

STATEMENT OF NONDISCRIMINATION: It is the policy of our Academy not to discriminate or engage in harassment on the basis of race, color, national origin, sex, religion, age, disability, or any other legally protected status in its educational and vocational programs, services or activities or matters related to employment as required by Title VI and Title VII of the Civil Rights Act of 1964, as amended; Title IX of the Education Amendments of 1972; Age Discrimination in Employment Act; Americans with Disabilities Act, as amended; and Section 504 of the Rehabilitation Act of 1973, as amended.

Inquiries regarding the Academy’s non-discrimination policies in the following areas should be directed to: Tonya Johnson-Smallwood, SHRM-SCP, Human Capital Director at 713.394.3584 or [email protected].

Energized For Excellence Academy

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