New Instructor Information

Date of Birth *

MM

DD

YYYY

Phone *

(###)

###

####

Present Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have the legal right to work in the US? *

Yes

No

How soon can you start? *

MM

DD

YYYY

Personal Reference 1 *

First Name

Last Name

Phone *

(###)

###

####

Personal Reference 2

First Name

Last Name

Phone

(###)

###

####

Personal Reference 3

First Name

Last Name

Phone

(###)

###

####

Phone

(###)

###

####

Phone

(###)

###

####

Phone

(###)

###

####

Please Read Carefully Before Submitting *

All information contained in this application is true to the best of my knowledge and belief. I authorize investigation of all statements and related information contained in this application unless herein specifically stated otherwise. I agree that any false statements or answers in this application or any misleading or incorrect statements, misrepresentations or omissions of facts made by me may render this application void. Request Consumer Report Information: I understand that ESAA may utilize the services of a consumer reporting agency as part of the procedure for processing my application. I also understand if my application is granted, ESAA may obtain further information through subsequent investigations by a consumer reporting agency. I understand a consumer reporting agency’s investigation may include obtaining information covering up to the last seven (7) years regarding my credit background, references, character, past employment, work habits, education, general reputation, personal characteristics, mode of living, judgment, liens, and criminal background. I understand such information may be obtained by direct or indirect contact with former employers, schools, financial institutions, landlords and public agencies or other persons who may have such knowledge. I also understand that before my application is denied based, in whole or part, on information obtained in the report, I will be provided a copy of the report and a description in writing of my rights under the Fair Credit Reporting Act. I understand if I disagree with the accuracy of any information in the report, I must notify El Segundo Arts Academy within two (2) days of my receipt of the report. If I notify ESAA within two days of the receipt of the report that I am challenging information in the report, ESAA will not make a final decision on my application status until after I have had a reasonable opportunity to address the information contained in the report. I hereby consent to this investigation and authorize ESAA to procure a report on my background as stated above from a consumer reporting agency.

First Name

Last Name

Today's Date *

MM

DD

YYYY