Special Recreation Services Employment Application

Employment Application:

If you have already submitted an application within the past year, you DO NOT have to re-apply. Please call or email us. If something on this application does not pertain to you, please put N/A
Personal Information:
Full Name *

First Name Middle Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
County *
(Monroe, Pike, Carbon, etc)
Township/ Borough in which you pay school taxes *
(For example you live in Tannersville but your township is Pocono)
Phone Number *

Area Code Phone Number
E-mail *
Where did you see our job advertisement? *

Facebook Craigslist newspaper Indeed Other
Are You a U.S. Citizen? *

Yes No
Are You legally eligible to work in the U.S? *

Yes No
Are You a U.S. Veteran? *

Yes No
If selected for employment are you willing to submit to a background check and a drug test? *

Yes No
Do you understand that you need a vehicle with current inspection and registration *

Yes No
Employment Desired:
Position Applying for: *

Direct Support Professional (DSP) Direct Support Professional with Autism Ecperience
Geographic area you prefer: *

East Stroudsburg/Stroudsburg Mt. Pocono/Tobyhanna Kunkletown/Jonas Albrightsville/ Carbon County Wayne/Pike County Bucks County Northampton County Lehigh/Berks County
Date You Can Start *

Month Day Year
Salary Desired *
Employment desired? *

Part-Time Full-Time Summer/Temporary/Per Diem
Education:
High School *
Name of High School Attended
High School Address (City and State) *
Graduated? *

Yes No GED
College
Name of College/University Attended
Number of Years Attended
Graduated?

Yes No
Area of Study/Degree
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

Yes No
Area of Study/Degree
Skills/Qualifications:
Skills
List any relevant skills
Please list any languages you speak besides English. Please include if you are trained in Sign Language.
List any relevant skills
Qualifications
List any relevant certifications or qualifications
Current Employment:

If you have not been employed recently, please list any recent volunteer experience.
Current Employer/Most Recent Employer *
Name of Current Employer or NONE if not Employed
Position *
Job duties *
Reason for Leaving? *
Start Date *

Month Day Year
May We Contact? *

Yes No
End Date *

Month Day Year
Date
Supervisor's Name *
Supervisor's Phone Number *

Area Code Phone Number
Previous Employment:
Previous Employer *
Name of Previous Employer
Position *
Job Duties *
Reason for Leaving? *
Start Date *

Month Day Year
End Date *

Month Day Year
Supervisor's Name *
Phone Number *

Area Code Phone Number
References:

Do NOT include relatives or anyone that lives with you.
Reference 1 *
Name of Reference
Relationship *
Occupation of Reference 1 *
Name of Reference
Years Acquainted *
Phone Number *

Area Code Phone Number
Email
To send them a reference form to fill out
Reference 2 *
Name of Reference
Relationship *
Occupation of Reference 2 *
Name of Reference
Years Acquainted *
Phone Number *

Area Code Phone Number
Email
To send them a reference form to fill out
Reference 3 *
Name of Reference
Relationship *
Occupation of Reference 3 *
Name of Reference
Years Acquainted *
Phone Number *

Area Code Phone Number
Email
To send them a reference form to fill out
Cover Letter & Resume (Optional):
Cover Letter
Resume
Send Application:
Please read and electronically sign below: The information I have provided above is correct and truthful to the best of my knowledge. I understand that any false statements provided by me to Special Recreation Services in this application or interview could result in non-hiring or termination of my position. I also understand that filling out this application does not guarantee a position with Special Recreation Services.
Signature *

Clear
Should be Empty:

Employment Application:

Personal Information:

Employment Desired:

Education:

Skills/Qualifications:

Current Employment:

Previous Employment:

References:

Cover Letter & Resume (Optional):

Send Application: