Please provide three references who we can contact. (Examples: personal, professional, pastoral, academic)

Please list your previous employers starting with most recent and going back in time. This could include
working for yourself, serving in the military, summer and part-time jobs.

I understand that any participation in the Keim Work Study Program would be “at-will,”meaning that I or Keim could end my participation at any time, or for any reason consistent with applicable state or federal laws. I also acknowledge that I will complete all contracts, consents, and requirements that my school requires of students who participate in a work study program and will abide by and comply with all expectations of my school and Keim throughout my work study participation should I be accepted into the program.
I permit Keim to conduct a full background investigation of my work and educational history, and to confirm all information given on this application and during interviews is true. I release Keim, and its representatives or agents, from any liability that might result from such an investigation. I permit all individuals, schools, employers and companies named in
this application to provide any requested information and release them from all liability for providing the requested information.

I will complete any post-offer physical evaluations that Keim may require including testing for illegal or unauthorized drugs or other substances. I understand that any offer of participation in the Keim Work Study Program is contingent upon my successfully passing any physical evaluation requirements and background investigation.

I certify that all statements in this completed application are true and I understand that any falsification or willful omission are enough cause for dismissal from the program or employment or refusal to approve participation in the program. My signature below confirms that I have read and understand the entire application and that I agree to the terms and conditions outlined above.