Employment Application

Personal Information

Full Legal Name *

Date of Birth (MM/DD/YYYY) *

Social Security Number (Last 4 for initial screening) *

Current Address *

Phone Number *

Email Address *

Position Information

Position Applying For *

Availability (Start Date) *

Employment History (Last 10 Years)

Employment History *

Education and Certifications

Highest Level of Education *

Institution(s) Attended *

Certifications *

Professional References

Include contacts not related to you, preferably former supervisors.

Reference 1 *

Reference 2 *

Reference 3 *

Criminal History Disclosure

Federal law requires disclosure for roles involving minors. A "yes" response does not automatically disqualify you.

Have you ever been convicted of, pled guilty/no contest to, or forfeited bail for any criminal offense (excluding minor traffic violations)? *YesNo

If yes, provide details (dates, charges, outcomes) * (Required if "Yes" selected)

Authorizations and Consents

I authorize Legacy Haven Academy to conduct a criminal background check, sex offender registry search, child abuse/neglect registry check, and fingerprint-based FBI check as required by federal law (34 U.S.C. § 20351 and Adam Walsh Act). I understand checks must be completed within 90 days of hire.

I authorize contact with references and previous employers for verification.

I consent to drug screening as required for the position (common in child-serving roles).

I am eligible to work in the US and will provide I-9 documentation upon hire (Immigration Reform and Control Act).

Electronic Signature *

Date Signed *

By typing my full name in the electronic signature field below, I certify that all information provided in this application is true and accurate to the best of my knowledge. I understand that providing false or misleading information may result in disqualification or termination. I acknowledge that my electronic signature is the legal equivalent of my handwritten signature and is binding for the purposes of this application, including all authorizations for background checks, reference verifications, and other consents required by Legacy Haven Academy. I agree that this electronic signature complies with applicable federal and state laws, including the Electronic Signatures in Global and National Commerce Act (E-SIGN) and the Uniform Electronic Transactions Act (UETA).

Thank you! We’ll be in touch soon. To expediate processing your application, please email your resume to admin@legacyhavenacademy.org.

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