Job Application - The Clearport

Application Date*

Date Available*

Personal Information

Name*

First Last

Birthday*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Email*

Social Security*

Daytime Phone*

Evening Phone*

Cell Phone*

Best time to call*

I would also be available to Substitute:

Yes
No

How long have you lived at the above address?*

Additional addresses where you have resided at any time during the past two years:

Address	City	State	# Years

Marital Status

Spouse's Name

Children's Names and Ages

Position Desired

Days and Hours Available

Position Applying For

How did you learn about the position for which you are applying?

List of subjects you can tutor

Education

Provide accurate, complete employment record. Start with present or most recent employer

College Major

Minor

Schools Attended

Name & Location of School	Dates Attended	# of years	GPA	Date of Graduation	Degree / Diploma

Employment

Employment Entries

Permission

Administration may contact the employers listed above unless indicated below.
DO NOT CONTACT:

1. Employer Name

1. Reason

2. Employer Name

2. Reason

References

I give permission to contact the following references:

1. Personal Reference

Phone

2. Recent Supervisor

Phone

Signature

I verify that I have read this application and declare that my answers are true and complete.

Printed Name*

Date*

Signature*

CONFIDENTIAL PERSONAL INFORMATION

This application is to be completed by all applicants for any position (volunteer or compensated) at The Clearport Learning Center. It is used to help provide a safe and secure environment for those children and youth who participate in our programs and our facilities.

1. Have you ever been investigated for, accused, suspected, indicted, or convicted of any crime involving child abuse, child sexual abuse, attempted sexual abuse of a minor, or any other crime involving children?*

Yes
No

1. If yes, please explain*

2. As an adult, have you ever abused or molested a minor in any way, regardless of whether there was any criminal investigation or conviction?*

Yes
No

2. If yes, please explain*

3. Have you ever been convicted of a D.U.I. offense?*

Yes
No

3. If yes, describe all convictions in the past five years*

4. Has your driver's license ever been revoked or suspended?*

Yes
No

4. If yes, describe all occurrences in the past five years*

5. Have you ever been convicted of felony?*

Yes
No

5. If yes, please explain detail*

Signature

I acknowledge that the answers to the above statements are true and complete. If necessary, I authorize The Clearport Learning Center to further investigate references, work records, evaluations, education or any other matters related to my suitability for employment. Furthermore, I authorize any references or former employers to disclose to the school any and all employment records, performance reviews, letter, reports and other information related to my life and employment, without giving me prior notice of such disclosure. In addition, I hereby release The Clearport Learning Center, my former employers, references and all other parties from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure. I waive the right to personally view any references given to The Clearport Learning Center.

Printed Name*

Date*

Signature*

Society Security #*

Background Information

At Clearport Learning Center, we strive to develop programs that go beyond the regular classroom setting. In what ways do you feel you could contribute to enhancing the lives of our students?

Mentorship is a large part of the responsibility of the staff at the learning center. What skills and experience do you have with mentoring youth?

We are looking for creative teachers that can design courses around the interests and needs of our students. What ideas and experience do you have in developing new and engaging lessons?

We will work on preparing our students for college and future careers. What experience do you have in preparing youth for future endeavors?

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