pg. 1
YPIC Employment Application Rev. 5.2023
YOUTH POSITIVE IMPACT COACHING EMPLOYMENT APPLICATION
YPIC is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age, or disability status. No question on this application is used to limit or exclude an applicant from employment consideration on a basis prohibited by local, state, or federal laws. Please complete this application in full, and finish by providing an original signature on the last page. Resumes cannot be accepted in lieu of an employment application.
GENERAL INFORMATION
Full Name:
Date:
-
Month
-
Day
Year
Date
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone:
Format: (000) 000-0000.
Email:
example@example.com
Position(s) Desired:
Circle One:
Full-Time
Part-Time
Contract
Available Start Date:
Salary Requirement:
How Referred to YPIC?
Are you willing to work hours outside 8:30am to 5pm, Monday through Friday, as needed?
YES
NO
Do you maintain current automobile insurance?
YES
NO
Do you have a valid Texas driver license?
YES
NO
Have you lived outside of Texas within the past seven (7) years? If yes, please list the countries, cities, and states you lived in during the past seven years:
EDUCATION HISTORY
On the chart below indicate any and all educational institutions you have attended (beginning with high school) as well as any and all diplomas, degrees, and/or certificates you have received.
EDUCATION HISTORY
Rows
Name of Educational Institution
Location
Degree/Certification
Date Received
1
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pg. 2
YPIC Employment Application
Rev. 5.2023
PROFESSIONAL LICENSES
Complete the following information regarding any professional licenses you hold.
1. License:
License No:
Date Issued:
-
Month
-
Day
Year
Date
State:
2. License:
License No:
Date Issued:
-
Month
-
Day
Year
Date
State:
3. License:
License No:
Date Issued:
-
Month
-
Day
Year
Date
State:
EMPLOYMENT HISTORY
Please provide employment information for a minimum of past three (3) employers beginning with your current or most recent position. Use additional pages if necessary.
Employer:
Employer's Phone:
Format: (000) 000-0000.
Employment Address:
Position/Title:
Work Status (Circle One): Full-time / Part-time / Contract
Full-time
Part-time
Contract
Start Date:
-
Month
-
Day
Year
Date
Leave Date:
-
Month
-
Day
Year
Date
Beginning Salary:
Final Salary:
Supervisor Name/Title/Phone:
Responsibilities:
Reason for Leaving:
May we contact this employer?
YES
NO
Employer:
Employer's Phone:
Format: (000) 000-0000.
Employment Address:
Position/Title:
Work Status (Circle One): Full-time / Part-time / Contract
Full-time
Part-time
Contract
Start Date:
-
Month
-
Day
Year
Date
Leave Date:
-
Month
-
Day
Year
Date
Beginning Salary:
Final Salary:
Supervisor Name/Title/Phone:
Responsibilities:
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May we contact this employer?
YES
NO
Reason for Leaving:
Employer:
Employer's Phone:
Format: (000) 000-0000.
Employment Address:
Position/Title:
Work Status (Circle One): Full-time / Part-time / Contract
Start Date:
-
Month
-
Day
Year
Date
Leave Date:
-
Month
-
Day
Year
Date
Beginning Salary: $
Final Salary: $
Supervisor Name/Title/Phone:
Responsibilities:
Reason for Leaving:
May we contact this employer?
YES
NO
Employer:
Employer's Phone:
Format: (000) 000-0000.
Employment Address:
Position/Title:
Work Status (Circle One): Full-time / Part-time / Contract
Start Date:
-
Month
-
Day
Year
Date
Leave Date:
-
Month
-
Day
Year
Date
Beginning Salary: $
Final Salary: $
Supervisor Name/Title/Phone:
Responsibilities:
Reason for Leaving:
May we contact this employer?
YES
NO
SPECIAL SKILLS & QUALIFICATIONS
Summarize any job-related training, skills, computer knowledge, experience, or other information relevant to this position.
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Should be Empty: