Kid Zone Job Application Survey

1.Position Applying For:(Required.)

2.Full Name:(Required.)

Last Name:

First Name:

Middle Initial:

3.Address:(Required.)

Street w/apt #:

City:

State:

Zip Code:

4.Phone:(Required.)

Home:

Office:

Message:

5.Email:(Required.)

6.Do you possess a valid Driver's License:(Required.)

Yes

7.Your age group is?(Required.)

15-17 years

18-20 years

21 years +

8.Are you a U.S. Citizen or non-U.S. Citizen authorized to work in the United States?(Required.)

Yes

9.Have you ever worked for the City of Tempe?(Required.)

Yes

If YES, When (Month/Year):

10.Are you related to any member of the Tempe City Council or any Tempe Commission/Board Member, or any City of Tempe employee?(Required.)

Yes

If YES, please indicate his/her name, position, and relationship to you:

11.To assist us with verifying your previous work experience and/or education, please list other names you have gone by:(Required.)

12.Are you a veteran?
Note: If you are claiming Civil Service Preference for Veterans under ARS 38-492, you must submit a copy of your DD214(Member-2 or 4) at the time you are invited to a testing process.(Required.)

Yes

13.Date Available:(Required.)

From

14.Times Available:(list all times available on each day available)(Required.)

Mondays

Tuesdays

Wednesdays

Thursdays

Fridays

15.Have you obtained a high school diploma or a high school equivalent certification?(Required.)

Yes

High School Name:

16.Education from an accredited College/University:

#1 Name:

#1 Major:

#1 Type of Degree:

#1 Degree Completed: (yes or no)

#2 Name:

#2 Major:

#2 Type of Degree:

#2 Degree Completed: (yes or no)

17.Trade and/or Technical Schools:

Trade and/or Technical Schools:

Subject Studied:

Type of Degree:

Degree Completed: (yes or no)

18.Certification or Registration: (CPR, First Aid, Adv. Lifesaving, Lifeguard Training, W.S.I, etc)

Current Type of Certifications:

License Number:

Date Received:

Expiration Date:

19.Special training that relates to this position:

20.List computer software program(s) with which you are proficient in operating that relate to this position:

21.Language Proficiency (other than English):

Language:

Speak: (yes or no)

Read: (yes or no)

Write: (yes or no)

22.Job Experience: (Begin with your present or most recent position. List all jobs, paid or volunteer, for at the the past 10 years. Your qualifications will be evaluated solely on the application form and, if applicable, any supplemental questionnaire(s).)

#1 Place of Employment or Volunteer Experience:

Phone Number:

Address (street, city, state, zip):

Your Title:

Number of employee supervised:

Supervisor Name/Title/Phone:

Employment Date: (mm/yy)

Hours Per Week:

Wage (per hour): $

Work Performed:

Reason for leaving or wanting a change:

23.Job Experience:

#2 Place of Employment or Volunteer Experience:

Phone Number:

Address (street, city, state, zip):

Your Title:

Number of employee supervised:

Supervisor Name/Title/Phone:

Employment Date: (mm/yy)

Hours Per Week:

Wage (per hour): $

Work Performed:

Reason for leaving or wanting a change:

24.Job Experience:

#3 Place of Employment or Volunteer Experience:

Phone Number:

Address (street, city, state, zip):

Your Title:

Number of employees supervised:

Supervisor Name/Title/Phone:

Employment Date: (mm/yy)

Hours Per Week:

Wage (per hour): $

Work Performed:

Reason for leaving or wanting a change:

25.Have you ever been requested or forced to resign from a position for misconduct or unsatisfactory service?

Yes

If Yes, please explain

27.PLEASE READ THIS STATEMENT AND CAREFULLY REVIEW YOUR ENTIRE APPLICATION MATERIAL BEFORE SIGNING BELOW.

I certify that all statements made on the application form and, if applicable, any supplemental questionnaire(s) are true and complete. I understand that any omission, misstatement, or falsification may be cause for rejection of this application, removal of my name from an eligibility list(s), and/or discharge from City Service. In addition, I authorize any individual, company, organization, or institution to release any and all information concerning statements made by me on my application, and I do hereby release all parties and individuals connected therewith from all liabilities for any damages whatsoever incurred in furnishing such information.(Required.)

Print Full Name:

Date:

28.Professional References: (if you have never worked before please list a non-family member adult (teacher, coach, etc))(Required.)

#1 Name/Title:

Address (street, city, state, zip):

Phone Number:

Email:

Dates Employed or Volunteered: (month/year)

29.Professional References: (if you have never worked before please list a non-family member adult (teacher, coach, etc))(Required.)

#2 Name/Title:

Address (street, city, state, zip):

Phone Number:

Email:

Dates Employed or Volunteered: (month/year)

30.Professional References: (if you have never worked before please list a non-family member adult (teacher, coach, etc))(Required.)

#3 Name/Title:

Address (street, city, state, zip):

Phone Number:

Email:

Dates Employed or Volunteered: (month/year)

31.Personal References: (friends, co-workers, etc)(Required.)

#1 Name/Title:

Address (street, city, state, zip):

Phone Number:

Email:

Dates Employed or Volunteered: (month/year)

32.Personal References: (friends, co-workers, etc)(Required.)

#2 Name/Title:

Address (street, city, state, zip):

Phone Number:

Email:

Dates Employed or Volunteered: (month/year)

33.Personal References: (friends, co-workers, etc)(Required.)

#3 Name/Title:

Address (street, city, state, zip):

Phone Number:

Email:

Dates Employed or Volunteered: (month/year)

34.I hereby authorize the Kid Zone Enrichment Program and the City of Tempe to check my references with the individuals listed above. To accept please print name below.(Required.)

Print Full Name:

Date: