Personal Data

Position Applying For:

How did you hear about this position:

Name

First

Middle

Last

Current Address

Address Line 1

Address Line 2

City

State

Zip Code

Previous Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Are you under 18 years of age?

Yes
No

Are you legally eligible for employement in the U.S.?

Yes
No

Employment Type

Complete Availability

Full Time
Part Time

Date Available

Do you have reliable transportation?

Yes
No

Do you have a valid driver's license?

Yes
No

Education and Training

High School Info

School Name

Highest Year Completed

9
10
11
12

Diploma

Describe Course of Study

Address

Address Line 1

Address Line 2

City

State

Zip Code

College/University

School Name

Years Completed

1
2
3
4

Degree

Describe Course of Study

Address

Address Line 1

Address Line 2

City

State

Zip Code

Graduate/Professional

School Name

Years Completed

1
2
3
4

Degree

Describe Course of Study

Address

Address Line 1

Address Line 2

City

State

Zip Code

Special Qualifications (Include Active Technical, Professional Licenses and Numbers, Academic or Professional Awards):

Foreign Language(s)

Spoken

Read

In Case of Emergency, Please Notify

Name

First

Last

Home/Cell Phone

Work Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Have you ever been dismissed or asked to resign from any position?

Yes
No

Employment History

In the space provided below, please enter your Employment History, beginning with your present employer and list all positions held, including military, part time, summer and any periods of unemployment.

Name of Employer

From

Month/Year

To

Month/Year

Phone

Job Title

Average Hours Worked Per Week

Name of Supervisor

Title of Supervisor

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Position and Duties

Briefly describe your position and duties

Reason for leaving

May we Contact this Employer

Yes
No

Any period of unemployment?

Yes
No

Criminal Phone Active

Criminal History

Have you ever been convicted of a crime or traffic offense?

Yes
No

Any conviction must be noted and will be evaluated along with information available to the Weinstein JCC. A conviction record will not necessarily be a bar to employment (Please note that by signing this application you authorize the Weinstein JCC to obtain criminal record information from law enforcement authorities.)

Has your privilege to operate a motor vehicle ever been denied, suspended or revoked?

Yes
No

Desired Hourly Rate or Salary

Amount

Rate

Per Hour
Per Year

Have you ever been a Weinstein JCC employee

Yes
No

Do you have any friends or relatives working for the Weinstein JCC

Yes
No

Have you previously worked or attended school under another name?

Yes
No

References

List three persons not related to you by blood or marriage who have not already been listed in the Employment History Section who can comment on your education and/or work experience

Name

First

Last

Occupation

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Name

First

Last

Occupation

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Name

First

Last

Occupation

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Equal Employment Opportunity

The Weinstein JCC is an Equal Opportunity Employer. We provide equal employment opportunities to all applicants and employees without unlawful discrimination based on race, color, religion, sex, national origin, age, disability, or any other protected characteristic under applicable law.

Applicant Certification

By signing below, I certify that the information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that any omission, misrepresentation, or falsification of information may result in my removal from consideration for employment or, if hired, termination of employment.

Authorization to Verify Information

I authorize the Weinstein JCC to verify the information contained in this application, including employment history, education, professional licenses, references, and other information relevant to my qualifications for employment. If applicable to the position, I also authorize the Weinstein JCC to obtain consumer or credit reports when permitted by law and when job-related.

Background & Motor Vehicle Record Checks

I understand that employment may be contingent upon satisfactory background screenings appropriate for the position. I authorize the Weinstein JCC to obtain criminal history information and, when driving is a requirement of the position, motor vehicle records from the appropriate agencies. I agree to complete any additional authorization forms required for these screenings.

Employment Eligibility

If offered employment, I understand I must provide documentation establishing my identity and authorization to work in the United States in accordance with federal law.

At-Will Employment

I understand that this application, any interview, the Employee Handbook, or any other communication does not constitute a contract of employment. If employed, my employment will be at will, meaning either I or the Weinstein JCC may terminate the employment relationship at any time, with or without notice, subject to applicable law.

Policies & Financial Obligations

I understand that, if employed, I am expected to follow all Weinstein JCC policies and procedures, which may be revised from time to time. I further understand that any outstanding financial obligations I owe to the Weinstein JCC at the time of separation may be deducted from amounts due to me to the extent permitted by law.

I certify that I have read, understand, and agree to the statements above.

Yes

Signature

Clear Signature

Name

First

Last

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Personal Data

Employment Type

Education and Training

High School Info

College/University

Graduate/Professional

Foreign Language(s)

In Case of Emergency, Please Notify

Employment History

Criminal History

Please list all unexpired licenses and permits:

Desired Hourly Rate or Salary

Previous Weinstein JCC Employement Info

Friends or Relatives that work for the Weinstein JCC

References

Equal Employment Opportunity

Applicant Certification

Authorization to Verify Information

Background & Motor Vehicle Record Checks

Employment Eligibility

At-Will Employment

Policies & Financial Obligations