Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Position * GiftedProducer - After School Artistic Instructor GiftedImpact Site Supervisor Date of Birth * MM DD YYYY Have you ever been convicted of a crime, pled no contest, or had adjudication withheld? * Yes No If yes, please provide a date, location, charges and a complete explanation of all offenses. EMPLOYMENT INFORMATION Preferred Job Status * Part Time Seasonal As Needed Volunteer Have you previously been employed at TheGifted Arts? * Yes No Have you previously volunteered at TheGifted Arts? * Yes No Have you ever been a member of GiftedAcademy? * Yes No EDUCATION High School Name Location (City, State) Graduate -- Yes No # of Years Completed * College School Name Location (City, State) Graduate -- No Yes # of Years Completed Degree/Major Tech/Trade?Post College Name Location (City, State) Graduate -- Yes No Number Degree/Major WORK EXPERIENCE Employer Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Start Date MM DD YYYY End Date MM DD YYYY Job Title Supervisor's Name May we contact Yes No Employer Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### State Date MM DD YYYY End Date MM DD YYYY Job Title Supervisor's Name May we contact? * Yes No Employer Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Start Date MM DD YYYY End Date MM DD YYYY Job Title Supervisor's Name May we contact? Yes No REFERENCES Please list any additional work-related or school/volunteer- related references that we may contact. Name Relationship Phone (###) ### #### Name Relationship Phone (###) ### #### Thank you for your submission. We will review your application and contact you soon.
