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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? *

What experience do you have working with children?

Can you make a commitment for the entire school year? *YesNoMark only one oval.

Are you a citizen of the United States? * *YesNoMark only one oval.

If no, are you authorized to work in the U.S.? *YesNoMark only one oval.

Have you ever been convicted of a felony? *YesNoMark only one oval.

EDUCATION

High School Year Started *

High School Year Completed/Expected To Complete *

Graduated High School? *YesNoMark only one oval.

College Year Started

College Year Completed/Expected To Complete

Major or Certificate

Graduated College? YesNoCurrently AttendingMark only one oval.

Alternative Education Year Started

Alternative Education Completed/Expected To Complete

Graduated Alternative Education? YesNoCurrently AttendingMark only one oval.

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

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? YesNoMark 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? YesNoMark 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? YesNoMark 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.

Language(s) Spoken besides English

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Agreement and eSignature *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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EMPLOYMENT APPLICATION

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EDUCATION

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.

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.

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.

ADDITIONAL INFORMATION