Driver’s license number/state/expiration (if job involves any driving)
Position Desired:
Program of Interest/Position applied for:
How did you hear about this position?
Dates available to work
Desired hours (full time, part time, etc.)
Education
Name and Address of School
Course of Study
Total Years of Study
Degree/Diploma
High School
Undergraduate College
Graduate/Professional
Other (Specify)
List any seminars, classes or other education not listed above which may help qualify you for this position
Volunteer Application
Employment History
List below all present and past employers over the past five years, starting with your most recent employer. Account for all periods of unemployment.
1.
Employer (current
No
)
Address:
Start Date
End Date
Essential job functions of final position
City, State, Zip:
Starting Salary
Ending Salary
1.
Phone number:
2.
Fax number:
Supervisor(s):
3.
Job position(s):
E-mail address of supervisor:
4.
Reason(s) for leaving
What value did you add to this company or its customers?
2.
Employer (current
No
)
Address:
Start Date
End Date
Essential job functions of final position
City, State, Zip:
Starting Salary
Ending Salary
1.
Phone number:
2.
Fax number:
Supervisor(s):
3.
Job position(s):
E-mail address of supervisor:
4.
Reason(s) for leaving
What value did you add to this company or its customers?
3.
Employer (current
No
)
Address:
Start Date
End Date
Essential job functions of final position
City, State, Zip:
Starting Salary
Ending Salary
1.
Phone number:
2.
Fax number:
Supervisor(s):
3.
Job position(s):
E-mail address of supervisor:
4.
Reason(s) for leaving
What value did you add to this company or its customers?
Additional Information
List any professional, trade, business or civic activities and offices held. You may exclude membership that would reveal gender, race, religion, national origin, ancestry, age, disability or any other protected status:
List any languages other than English that you can speak, read or write that could be of benefit to the position applied for:
Fluent
Good
Fair
Speak
Read
Write
Describe previous experience in working with pre-teens and adolescents:
Identify what skills or certification you possess related to this position:
If you are hired, what value would you add to our company?:
Describe what you believe are the most unique features of your work history:
Additional Information
Have you ever worked or volunteered with this company before? If Yes, when?
Yes
No
Do you have any friends or relatives working with this company? If Yes, please provide their names and relationship to you:
Yes
No
If you are under 18 years of age, can you provide proof of your eligibility to work?
Yes
No
If hired, can you provide proof of U.S. citizenship or proof of your legal right to work in the U.S.?
Yes
No
If driving is a requirement of the position applied for, have you in the last 7 years been convicted of Driving Under the Influence “(DUI)”
Yes
No
n/a
If hired, do you have a reliable means of transportation to and from work?
Yes
No
If hired, would you be able to travel or work overtime as needed?
Yes
No
Have you ever been convicted of a felony or misdemeanor? If Yes, please explain:
Yes
No
References
List below three persons not related to you who have knowledge of your work performance within the last 5 years, in particularly working with adolescents.
Name
Occupation
Company name
Address
Telephone
E-mail
Relationship & years acquainted
Name
Occupation
Company name
Address
Telephone
E-mail
Relationship & years acquainted
Name
Occupation
Company name
Address
Telephone
E-mail
Relationship & years acquainted
Additional Space Additional space provided to expand on any points or questions asked previously in this application?
