ALP Staff application 2025

ALP Staff Application Form 2025
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
SSN*
Phone Number*
Email Address*
Current Address*
School or Business Address
Home Church
Name & Address
Are you a U.S. citizen?*

YesNo
Are you authorized to work in the U.S.?*

YesNo
Days available:*

MondayTuesdayWednesdayThursday
What type of position do you want at the program? Your preference here*

Desired Salary? Your salary here*
Can you perform the essential functions of the job for which you have applied, with or without reasonable accommodation?*

YesNo
Past Work History
Provide a full record of all employment — paid and volunteer — and explain any gaps in employment. Include any positions on camp staff. Use a separate sheet, if necessary.
Please provide answer in this format: Dates/ Employer/ Manager/ Address/ Phone/ Position/ Reason for Leaving
Indicate any employer you do not wish for us to contact, and the reason
References
Please provide names and addresses of three persons [not relatives] having knowledge of your character, experience, work habits, and ability.*
Please provide answer in this format: Name/ Phone/ E-mail/ Professional Relation
Education
Please provide your education history: High School & Beyond*
Please provide answer in this format: Years/ School/ Major or Degree
Certifications & Support Skills
In the following list, please check those items in which you have experience and skills. If you are certified in these skills please attach a copy of your certification.

CPRcomputer/technicalMenu PlanningNursingcomputer/softwareFood Handler’s Permit/CertificationLifeguardbookkeeping/accountingCooking/Meal PrepFirst AidOther
Upload Certification Images Below:

Cancelof
If you checked other, please provide your other skills below:
Do you have a valid Driver's license*

YesNo
State Enter here*

License number Enter here*
Do you have a Commercial Driver's license*

YesNo
What does “Word and Deed” ministry mean to you?*
What contributions do you think you can make at the after school program?*
What contributions do you think a well-run program can make to children?*
Harassment
Jericho’s policy is to prohibit all forms of harassment by our employees. This includes sexual, racial, religious, and other forms of harassment. Have you ever been accused of harassment of any person including, but not limited to, workplace harassment? (Note: a prior accusation is not an automatic bar to employment. The type of accusation and when it occurred will be evaluated by the program before any decision is made.)*

YesNo
If yes, explain.
Criminal Record
Have you ever been convicted of a crime, other than a minor traffic offense? If yes, please describe.(Note: a prior conviction is not an automatic bar to employment. The type of conviction and when it occurred will be evaluated by Jericho before any decision is made.)*

YesNo
If yes, explain.
All statements become part of any future employee personnel files. I authorize investigation of all statements herein,including any checks of criminal records, and release the program and all others from liability in connection with thesame. I understand that, if employed, I will be an at-will employee unless there is an agreement or law which alters thatstatus. Furthermore, I understand that any agreement must be in writing and signed by the designated Jericho official. Ialso understand that misrepresentations or falsifications herein or in other documents completed or submitted by theapplicant will result in dismissal, regardless of the date of discovery by Jericho.
Signature

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ALP Staff Application Form 2025

Past Work History

References

Education

Certifications & Support Skills

Harassment

Criminal Record