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EMPLOYMENT APPLICATION
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Date of Birth
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Position Applying For
Firewall AmeriCorps Mentor - part-time
Firewall AmeriCorps Lead Mentor - part-time/full-time
Firewall AmeriCorps Program Manager - full-time
Program Director - full-time
Donor Relations Manager - full-time
Date Available to Start
How did you hear about this position?
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What experience do you have working with children?
Can you make a commitment for the entire school year?
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No
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Are you a citizen of the United States? *
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No
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If no, are you authorized to work in the U.S.?
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No
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Have you ever been convicted of a felony?
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Yes
No
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EDUCATION
High School Year Started
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High School Year Completed/Expected To Complete
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Graduated High School?
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No
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College Year Started
College Year Completed/Expected To Complete
Major or Certificate
Graduated College?
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No
Currently Attending
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Alternative Education Year Started
Alternative Education Completed/Expected To Complete
Graduated Alternative Education?
Yes
No
Currently Attending
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PREVIOUS EMPLOYMENT #1
If you have a resume with your previous employment information, please email it to employment@firewallcenters.org. You do not need to complete the following sections if you email it.
Company
Job Title
Employed From - Until
Starting Employment Date
Date Ending Employment
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Ending Salary
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Phone
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Reason for leaving
Let us know why you decided to leave this employer or the reason you were let go.
May we contact for a reference?
Yes
No
Mark only one option
PREVIOUS EMPLOYMENT #2
If you have a resume with your previous employment information, please email it to employment@firewallcenters.org. You do not need to complete the following sections if you email it.
Company
Job Title
Employed From - Until
Employed From - Until
Starting Employment Date
Date Ending Employment
Starting Salary
Ending Salary
Supervisor
Phone
Roles and Responsibilities
Give a us a snapshot/summary of your day-to-day responsibilities in the position.
Reason for leaving
Let us know why you decided to leave this employer or the reason you were let go.
May we contact for a reference?
Yes
No
Mark only one option
PREVIOUS EMPLOYMENT #3
If you have a resume with your previous employment information, please email it to employment@firewallcenters.org. You do not need to complete the following sections if you email it.
Company
Job Title
Employed From - Until
Employed From - Until
Starting Employment Date
Date Ending Employment
Starting Salary
Ending Salary
Supervisor
Phone
Roles and Responsibilities
Give a us a snapshot/summary of your day-to-day responsibilities in the position.
Reason for leaving
Let us know why you decided to leave this employer or the reason you were let go.
May we contact for a reference?
Yes
No
Mark only one option
ADDITIONAL INFORMATION
Skills
Give us some additional information about skills you have that can be an asset to us such as technological know-how, creative abilities or knowledge of physical activities.
Honors and Award
Let us know how you have been celebrated.
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Agreement and eSignature
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EMPLOYMENT APPLICATION DISCLAIMER AND ACKNOWLEDGEMENT I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to hire me, or for discharge should I be hired. I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for employment. I also authorize you to request and receive such information. In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added or interpreted at any time, at the company’s sole option and without prior notice to me. I also acknowledge that my employment may be terminated, or any offer or acceptance of employment withdrawn, at any time, with or without cause, and with or without prior notice at the option of the company or myself. APPLICANT WAIVER I hereby certify that the information hereunder is correct to the best of my knowledge and understand that falsification of this information is grounds for refusal to hire or, if hired, dismissal. I hereby authorize any of the persons or organizations listed in my application to give all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and release all such parties from all liability that may result from furnishing such information to you. I authorize you to request and receive such information. In consideration for my employment and my being considered for employment by your company, I agree to adhere to the rules and regulations of the company and hereby acknowledge that these rules and regulations may be changed by your company at any time, at the company’s sole option and without any prior notice. In addition, I acknowledge that my employment may be terminated, and any offer of employment, if such is made, may be withdrawn, with or without prior notice, at any time, at the option of either the company or myself. I understand that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to assure or make some other personnel move, either prior to commencement of employment or after I have Page 1 Employment Application Disclaimer become employed, or to assure any benefits or terms and conditions of employment, or to make any agreement, that is contrary to the foregoing. I hereby acknowledge that I have been advised that this application will remain active for no more than 90 days from the date it was signed.
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