Camp Employment Application Form

Camp Employment Application Form
POLICY

St. Peter's Episcopal School does not discriminate on the basis of race, color, national origin, sex, handicap, gender or age in its employement practices as required by Title VI of the Civil Rights Act of 1064, as amended; Title IX of the Education Amendments of 1972; the Age Discrimination Act of 1975, as amended; and Section 504 of the Rehabilitation Act of 1793, as amended.
Date of Application*

MonthDayYear
Date
Name Of Applicant*

First NameMiddle NameLast Name
Other name that may appear on records. Ex. Maiden name (used for reference and background checks)

First NameLast Name
Current Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone Number*

Area CodePhone Number
Email Address*
example@example.com
YesNo
If yes, where?*
YesNoContact Me First
Substitute Camp CounselorCamp CounselorCamp Craft CoordinatorSpecialty Camp Teacher
EDUCATIONAL BACKGROUND
Grade SchoolHighschoolAssociate's DegreeBachelor's DegreeMaster's DegreeDoctorate Degree
WORK HISTORY - Please provide consecutive Work History beginning with the most recent.
Current/Most Recent Employment: Company Name, Supervisor, Phone number or Email, Position Held*
Type N/A if not applicable
Reason for leaving:*
YesNo
Previous Employer: Company Name, Supervisor, Phone number or Email, Position Held
Leave blank if not applicable
Reason for leaving:*
YesNoN/A
Have you ever been discharged or requested to resign from any position? If yes, please explain.*
GENERAL INFORMATION
What date would you be available to start work?

MonthDayYear
Date
REFERENCES

List the names and email/phone number of at least two persons, not related to you, who can speak with knowledge of your personal and professional qualifications for the assignment which you seek.
1st Reference*

First NameLast Name
1st Reference Phone Number

Area CodePhone Number
1st Reference Email
example@example.com
2nd Reference*

First NameLast Name
2nd Reference Phone Number

Area CodePhone Number
2nd Reference Email
example@example.com
3rd Reference

First NameLast Name
3rd Reference Phone Number

Area CodePhone Number
3rd Reference Email
example@example.com
APPLICATION AGREEMENT

I hereby affirm that all information provided in this application is true and accurate to the best of my knowledge and understand that any deliberate falsifications, misrepresentations or ommissions of fact may be grounds from rejection of my application or dismissal from subsequent employment.

I authorize the references listed to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all such parties from liability for any damage that may result from furnishing the same to you.

I understand that the school is authorized by Tennessee Education Code 49-6-3001(c)(3)(A)(iii) to obtain criminal history record information on applicants the school intends to employ.
Please sign to agree to these terms. This application becomes the property of St. Peter's Episcopal School upon signature. The school reserves the right to accept or reject it. This application shall be considered active for a period not to exceed two years. Any applicant wishing to be considered for employment beyond this time period may not inquire as to whether or not applications are being accepted at that time. *
ADDENDUM TO APPLICATION

St. Peter's Episcopal School is required by state law to obtain criminal history record information on all applicants that are being seriously considered for employment with the school. Tennessee Education Code Section 0520-2-3.21 The information requested below is necessary to obtain criminal history record information.
Maiden or other name

First NameLast Name
Date of birth*

MonthDayYear
Date
MaleFemale
Height*
Weight*
Hair Color*
Eye Color*
Race*
Place of Birth*
Country of Citizenship*
Driver's License Number*
Driver's License State*
Social Security Number (no dashes)*
Have you ever been convicted of a felony? If yes, please explain.*
Type N/A if not applicable
I understand that the information that I am providing about age, sex or any other personal and historic information will be used to determine eligibility for employment to the position for which I am applying, but will be used solely for the purpose of obtaining criminal history record information as mandated by the laws of Tennessee. *
Today's Date*

MonthDayYear
Date
Should be Empty: