Step Ahead Enterprises

Step Ahead Enterprises

Employment Application
APPLICANT INFORMATION
Position Applying For:*

Residential Youth Care ProfessionalAdministrationMaintenance TeamOther
Name*

First NameLast Name
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How long at current address?*

YearsMonths
Phone Number*

Area CodePhone Number
Phone Number

Area CodePhone Number
Date of Birth*

MonthDayYear
Number of years experience working with youth*
Explain this experience (where/with who)*
Group Home Experience?*

YesNo
If yes, what agency?
Do you have any criminal charges within the last 7 years?*

YesNo
If yes, please explain
Please check all that apply to your personal and legal history*

Convicted of a FelonyDUI or DWICurrent Suspended LicenseUnable to work with childrenSmoke CigarettesSmoke MarijuanaUse any form of DrugsDrink AlcoholHealth ConditionsTaking Prescription MedicationNot applicable
Please check all documentation that you currently possess*

Fingerprint Clearance CardCPRFirst AidCPI TrainingHealth Assessment TrainingHigh School GED diplomaCollege Diploma or CreditsAZ Driver's LicenseAuto InsurancePhysical (within 2 years)TB Test (within 2 years)Form 1083Notarized Criminal Self-Disclosure Affidavit
UPLOAD ALL DOCUMENTATION CHECKED ABOVE

Upload a File

Cancelof
RESUME UPLOAD

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Availability (check all that apply)*

Mon-Fri 3pm-11pmMon-Fri 11pm-7amWeekend daysWeekend nightsEntire Weekend shift
Gender*

MaleFemale
Race/Ethnicity*
Religious Preference*
EDUCATION
Name of Last School Attended*
Highest Grade Level Comleted*
2 REFERENCES NEEDED
Reference #1: Current or most recent employment
Reference #1 Name*

First NameLast Name
Reference Job Title
Company Name
Valid Email*
example@example.com
Phone Number*

Area CodePhone Number
Reference relation*
coworker, supervisor, personal friend, etc...
Your Job Description
Date Started (if work related reference)

MonthDayYear
Date Finished (if work related reference)

MonthDayYear
Reference #2: Personal Character Reference (non-family)
Reference #2 Name*

First NameLast Name
Valid Email*
example@example.com
Phone Number*

Area CodePhone Number
Reference relation*
Coworker, supervisor, personal friend, etc...
Your Job Description (if work related reference)
Years known
number of years you've known reference
Date Started (if work related reference)

MonthDayYear
Date Finished (if work related reference)

MonthDayYear
Reference #3 Name

First NameLast Name
Reference Job Title
Company Name
Valid Email*
example@example.com
Phone Number*

Area CodePhone Number
Reference relation*
Coworker, supervisor, personal friend, etc...
Your Job Description (if work related reference)
Date Started (if work related reference)

MonthDayYear
Date Finished (if work related reference)

MonthDayYear
Reference #4 Name

First NameLast Name
Reference Job Title
Company Name
Phone Number*

Area CodePhone Number
Valid Email*
example@example.com
Reference relation*
Coworker, supervisor, personal friend, etc...
Your Job Description (if work related reference)
Date Started (if work related reference)

MonthDayYear
Date Finished (if work related reference)

MonthDayYear
Medical Information

Medical Condition

Rows	Excellent Condition	Satisfied	Needs Improvement	Poor Condition	Medical Assistance Needed
Vision
Hearing
Dental
Physical Condition

Any Surgeries, Special Needs, or Conditions*

YesNo
If yes, Please explain
Distinguishing Marks, Scars, or Tattoos?
EMERGENCY CONTACT
Emergency Contact's Name*

First NameLast Name
Emergency Contact's Phone Number*

Area CodePhone Number
Date*

MonthDayYear
Should be Empty:

Step Ahead Enterprises

Reference #1: Current or most recent employment

Reference #2: Personal Character Reference (non-family)