PDY/PAY Afterschool Program Employee Application

Name*

First NameLast Name

Date of Birth *

MonthDayYear

Home Phone Number *

Please enter a valid phone number.

Cell Phone Number *

Please enter a valid phone number.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How long have you lived at this residence?*

How were you referred to us?*

Other:

Are you Eligible to work in the U.S.?*

YesNo

Are you currently 18 years of age or older?*

YesNo

Have you ever been accused or convicted of a crime against children?*

YesNo

If yes, please explain. Include date, city, state and final conviction.

High School Name:*

Did you graduate? If so, please list the year.*

If not, how many years are left before graduating?*

#1 College/University:*

Did you graduate? If so, what year? (if applicable) *

Degree Received/Current Major:*

#2 College/University:*

Did you Graduate? If so, what year: (If applicable)*

Degree Received/Current Major:*

Please provide a list your job duties/responsibilities for the employment listed above: *

Share with us, why you are interested in becoming part of the PDY/PAY team?*

What position are you applying for? (Please refer to www.pdypay.com for job descriptions and qualifications)*

Lead TeacherAssistant TeacherTutor

Please provide a list of skills you possess that qualify you for your selected position: *

Upload your resume:*

Name:*

Phone Number:*

Number of Years this person has known you:*

Name:*

Address:*

Phone Number:*

How long did you work with/for this employer?*

Would you be willing to wear a mask during the workday if required?*

YesNo

I certify that the information on this application is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize 21st CCLC Afterschool Learning Center to investigate, without liability, all statements contained in this application. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requestd, I agree to sign criminal backgrounds investigation, and/or screening for illegal substances up on conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that staff employess of 21st CCLC Afterschool Learning Center serve at-will, and the employment relationship may be terminated at any time by either party, for any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States. I understand that the first THREE MONTHS of employment represent a probationary period.

I verify that I have read and understood the above statement.

Please Sign Below:*

PDY/PAY Afterschool Program Employee Application

Education

Employment Record

Job Skills & Training

References

Personal Reference

Employment Reference

PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION: