Project Impact - Employment Application

Project Impact Employment Application

All applications for all positions will be considered without regard to race, religion, sex, national origin, age, marital or veteran status, the presence of a non-job related medical condition or handicap, or any other legally protected status. Please bring Driver's License and Social Security Card to interview.

* Position applied for:
Site Coordinator
Teacher
Paraprofessional
Student worker

How did you hear about this position
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Employment Agency

* Last Name:

* First Name:

* Address:

Work Phone:

Cell Phone:

* Date of Birth:

* Have you worked with Project Impact before?
Yes
No

If you are under 18 years of age, can you provide required proof of your eligibility to work?
Yes
No

* Are you currently employed?
Yes
No

* May we contact your employer?
Yes
No
N/A

* Are you prevented from lawfully becoming employed in this country because of Visa of Immigration Status?
Yes
No

* When will you be available for work?

* Have you been convicted of a felony within the last 7 years?
Yes
No

If you answered YES to the question above, please explain

* EDUCATION:
Currently a student
High School Diploma/GED
Special Certificate
Community College AA Degree
Bachelor's Degree
Master's Degree

Do you have any specialized training, honors, foreign language fluency, or additional information that may be relative to your employment? Please list:

Please list professional, trade, business or civic activities and/or offices held: (You may exclude memberships which would reveal sex, race, religion, national origin, age, or handicaps.)

* REFERENCES:

Current or most recent employer & phone:

Type of Employment

Reason for leaving:

2nd Employer Name & Phone:

Type of Employment

Reason for leaving:

3rd Employer Name & Phone:

Type of Employment:

Reason for leaving:

Additional special skills and qualifications:

APPLICANT'S STATEMENT: I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for emplolyment as may be necessary. If hired, I agree to a drug screening and background check as required. NOTE: False or misleading information given on this application or during an interview may result in discharge.
Yes
No

* Required