Job Application

PERSONAL INFORMATION

EDUCATION

Please list your names of schools and locations, degree or area of study, date enrolled, and date graduated.

WORK EXPERIENCE: LIST CHRONOLOGICALLY STARTING WITH CURRENT POSITION (Past 6 years)

Click or drag a file to this area to upload.
Click or drag a file to this area to upload.

For Licensed Clinical and Medical Personnel Only

READ CAREFULLY BEFORE SIGNING

I certify that all information I have provided herein; i.e., application, resume, interview: is true and correct and that I have made no effort to conceal pertinent information. I authorize my former employers, schools and references to provide any information they may have regardingme, whether or not it is intheir records. I herby release them and their company from all liability for divulging same. I understand that all statements made are open to investigation by Miracle Kids Success Academy/Kids Unlimited Learning Academy, and if hired, if any information given by me in this application or resume is found to be false or misleading, I will be subject to dismissal at any time during the period of employment and I agree to hold Miracle Kids Success Academy/Kids Unlimited Learning Academy and persons named herein blameless in that event. I give permission to Miracle Kids Success Academy/Kids Unlimited Learning Academy to administer any required background checks to complete the application process. If hired, I understand I will be subjected to drug testing upon hire and randomly thereafter.

If employment is obtained under this application, I will comply with all the rules and regulations of the company. I agree to be responsible for company property and equipment issued to me by the company until returned by me and to pay for property and equipment not returned. Further, I understand and agree that my employment is for no definite period of time and may, regardless of date of ppayment of my salary, be terminated at any time by Miracle Kids Success Academy/Kids Unlimited Learning Academy. I further understand that no representative of the company has authority to make any agreement contrary to the forgoing except the Chief Executive Officer of Miracle Kids Success Academy/Kids Unlimited Learning Academy and any such agreement must be in writing and signed by the Chief Executive Officier and applicant/employee. As a condition of my employment, I agree to arbitrate all disputes arising in connection with this employment relationship pursuant to Federal Arbitration Act.

I agree that all company policy and procedure, forms, electronic forms and software to which I gain are the confidential trade secrets of Miracle Kids Success Academy/Kids Unlimited Learning Academy. I further undertand that as a condition of employment, I may be requiredto sign a confidentiality agreement protecting the property of Miracle Kids Success Academy/Kids Unlimited Learning Academy. I hereby authorize Miracle Kids Success Academy/Kids Unlimited Learning Academy to contact my former employers to obtain information concerning my employment and the reason for my termination of employment. I authorize my former employers to release and disclose to Miracle Kids Success Academy/Kids Unlimited Learning Academy any information pertaining to my employment and termination of employment. I hereby release Miracle Kids Success Academy/Kids Unlimited Learning Academy and my former employers from any and all damages, liabilities and claims that may result from the release and disclose of such information.

Due to the nature of ur peration and to ensure the safety of our patients and communities we serve, we have designated certain positions as "safety sensitive". Positions in these classifications could be required to undergo pre-employment drug-testing and be subject to further random drug-testing throughout the period of employment.