Non-Teaching Application - Employment - Jackson Preparatory & Early College

(An Equal Opportunity Employer)

Date mm/dd/yyyy

Name

Address

Mailing Address (if different than above)

Telephone Number

Email Address

Position(s) Desired

Educational Background:

Highest Level of School Completed

Further Education and Training

__________________________________________________________________________________________________________________________________________________________________________

Previous Employers:

Name and Address of Previous Employer

Immediate Supervisor

Type of Work

Reason for Leaving

Dates of Employment

__________________________________________________________________________________________________________________________________________________________________________

Name and Address of Previous Employer

Immediate Supervisor

Type of work

Reason for Leaving

Dates of Employment

__________________________________________________________________________________________________________________________________________________________________________

Name and Address of Previous Employer

Immediate Supervisor

Type of Work

Reason for Leaving

Dates of Employment

__________________________________________________________________________________________________________________________________________________________________________

Skills & Experience Relevant to Position(s) Desired:

__________________________________________________________________________________________________________________________________________________________________________

References

Reference 1: Occupational (preferred) or Personal Name, Address, Telephone Number

Reference 2: Occupational (preferred) or Personal, Name, Address, Telephone Number

Reference 3: Occupational (preferred) or Personal, Name, Address, Telephone Number

Have you ever been convicted of a felony or misdemeanor including a traffic violation? (required) Yes No

If yes, provide details

Failure to disclose will result in immediate termination of employment

__________________________________________________________________________________________________________________________________________________________________________

Affidavit:

I hereby declare all the foregoing statements to be complete and true.

Electronic Signature

Date mm/dd/yyyy