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

Current Salary

Educational Background:

Highest Level of School Completed

Further Education and Training

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Previous Employers:

Name and Address of Previous Employer

Immediate Supervisor

Type of Work

Reason for Leaving

Dates of Employment

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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:

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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

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Affidavit:

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

Electronic Signature

Date MM/DD/YYYY