Blue River Career Programs Certified Application

Blue River Career Programs

Please fill out all required parts of the application. Blue River Career Programs is committed to equal opportunity. It is an Equal Opportunity-Affirmative Employer and does not discriminate on the basis of age, race, color, religion, sex, handicapping conditions, or national origin including limited English proficiency, in any employment opportunity. No person is excluded from participation in, denied the benefits of, or otherwise subjected to unlawful discrimination on such basis under any educational program or student activity.
Position for which you are applying: *
Name*

First NameMiddle NameLast Name
Home Phone/Cell Phone: *
Birth Date*

MonthDayYear
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Educational Background - High School*
Name of High School, Year Graduated, Location
Educational Background - Technical, College, or University*
Name of Technical, College, or University, Dates Attended, Location, Degree Major/Minor, Date
Work Experience*
Employer & Location, Date, Position Held, Reason for Leaving
Work Experience*
Employer & Location, Date, Position Held, Reason for Leaving
Work Experience*
Employer & Location, Date, Position Held, Reason for Leaving
Work Experience*
Employer & Location, Date, Position Held, Reason for Leaving
Resume and Files*

Please add resume, copy of administrative and/or teaching license, and/or three letters of reference.
Cancelof
Training and Certifications
Training and Certifications
Training and Certifications
References

Please list three (3) professional references that are familiar with your work.
Reference*
Reference*
Reference*
Memberships and Affiliations (List Professional and Social)
List all memberships and affiliations you are a part of. Include organization, remarks, and dates
Community Activities
Please list all community activities you are involved in which will include organization, remarks, and dates.
Military Experience
Please list any military experience which includes date of entry, discharge date, branch, rank, years of active service, and type of discharge. Type N/A if you have not served in the military.
Are you presently being investigated or under a procedure to consider your discharge for misconduct by your present employer?*

YesNo
Have you ever been reprimanded, disciplined, discharged, or asked to resign from a prior position?*

YesNo
Have you ever resigned from a prior position without being asked, but under circumstances involving your employer's investigation of sexual conduct with another person, mishandling of funds, or criminal conduct?*

YesNo
Have you ever been charged with, pled guilty, or "no contest" to, or been convicted of, any crime involving sexual abuse of any person or any other crime or moral turpitude?*

YesNo
Have you ever been convicted of misdemeanor and/or felony, or ever entered a plea of guilty or a plea of "no contest", or has any court ever deferred further proceedings without entering a finding of guilty or placed you on probation for a crime?*

YesNO
If you answered YES to any of the five questions above, please explain below.
Statement of Understanding:

I certify that in the information I have given on this application is true and complete to the best of my knowledge and I understand and agree that any false information or the omission of any information shall be considered as sufficient cause for my discharge.

I hereby consent to and authorize representative of Blue River Career Center to investigate my employment history and personal references and to make any other investigations deemed necessary with this application
Applicant's Signature/Date
Please sign and date
Should be Empty: