KML Application

Do you know of anything that would prevent your future employment?*

YesNo
Please explain*
Please list any extracurricular activities, clubs or community organizations, etc.*
In 250 words or more, write an essay about yourself, your family, and your life experiences. 250 words is an approximate number, not an absolute. However, shorter may not give us a clear picture of you as compared to other applicants. Your essay will also give us the chance to see your writing ability so be sure to pay attention to neatness, paragraphs, spelling, grammar, and punctuation. *

Must be minimum of 250 Words0/0

Employment

List all of your previous employers starting with the most recent employer
Have you ever been or are currently employed?

YesNo
Employer 1
Employer*
Are you still currently employed here?

YesNo
Start*

MonthDayYear
Date
End*

MonthDayYear
Date
Employer 2
Employer
Start

MonthDayYear
Date
End

MonthDayYear
Date
Employer 3
Employer
Start

MonthDayYear
Date
End

MonthDayYear
Date
Employer 4
Employer
Start

MonthDayYear
Date
End

MonthDayYear
Date
Employer 5
Employer
Start

MonthDayYear
Date
End

MonthDayYear
Date

References other than relatives
Reference 1
Full Name*

First NameLast Name
Relationship*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 2
Full Name*

First NameLast Name
Relationship*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 3
Full Name*

First NameLast Name
Relationship*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 4
Full Name*

First NameLast Name
Relationship*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I certify that I have not knowingly withheld any facts or circumstances in completing this application and it is further agreed that any misrepresentation by me in this application will be sufficient cause for rejection of this application. I authorize KML Foundation, Inc. to conduct an investigation of the contests of this application and will not hold anyone liable who supplies information.
Student's Signature*

Clear
Click mouse and drag to sign
Parent/Guardian Signature (if under 18 years of age)

Clear
Click mouse and drag to sign
Please upload proof of residency with application (i.e. Driver's License, ID Card)*

Cancelof
OPTIONAL - Please take Photo of proof of residency (i.e. Driver's License, ID Card)
Should be Empty:

Employment