I have filled out an application for a position as a:

with Roots and Wings Learning Center. I have authorized the center to thoroughly interview the primary references which I have listed, any secondary references mentioned through interviews with my primary references or other individuals who know me and have knowledge regarding my testimony and work record. I also authorize the Center to thoroughly investigate my work records and evaluations, my educational preparation and all other matters related to my suitability for employment.

I authorize references and my former employers to disclose to the Center any and all employment records, performance reviews, letters, reports and other information related to my life and employment, without giving me prior notice of such disclosure.

In addition, I hereby release Roots and Wings Learning Center, my former employers, references and all other parties from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. I waive the right to ever personally view any references given to Roots and Wings Learning Center.

I agree that a photocopy or facsimile copy of this document and any signature shall be considered for all purposes as the original signed release on file.

Applicant's Full Name:

Applicant's Electronic Signature:

I understand that Roots and Wings Learning Center does not discriminate in its employment practices against any person because of race, color, national or ethnic origin, gender, age or disability.

I hereby certify that the facts set forth in this initial application are true and complete to the best of my knowledge. I understand that discovery of falsification of any statement or a significant omission of fact may prevent me from being hired or if hired, may subject me to immediate dismissal regardless of the time elapsed before discovery. If I am released under these circumstances, I further understand that I will be paid and receive benefits only through the day of release provided that I have met the required probationary periods as stated in the Employee Handbook.

I authorize Roots and Wings Learning Center to thoroughly interview the primary references which I have listed, any secondary references mentioned through interviews with primary references or other individuals who know me and have knowledge regarding my testimony and work record. I also authorize the school to thoroughly investigate my work records and evaluations, my educational preparation and other matters related to my suitability for the job.

I authorize references and former employers to disclose to the center any and all employment records, performance reviews, letters, reports and other information related to my life and employment, without giving me prior notice of such
disclosure. In addition, I hereby release the center, my former employers, references and all other parties from any and all claims, demands or liabilities arising out of or in any way related to such investigation and disclosure. I waive the right to ever personally view any reference given to the school.

Since I will be working with children, I understand that I must submit to a fingerprint check by the FBI and possibly other federal and state authorities. I agree to fully cooperate in providing and recording as many sets of fingerprints as are
necessary for such an investigation. I authorize the center to conduct a criminal records check. I understand and agree that any offer of employment that I may receive from the center is conditioned upon the receipt of background information,
including criminal background information. The center may refuse employment or terminate conditional employment if the center deems any background information unfavorable or to reflect adversely on the center or on me, as a role model.
I understand that this is only an application for employment and that no employment contract is being offered at this time.

I certify that I have carefully read and do understand the above statements.

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