Employment Application

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Greenacre Homes & School Employment Application
438 Eddie Lane
Sebastopol, CA 95472
(707) 823-8722

* Indicates required field

Name *

First

Last

Date *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

2nd Phone Number *

PLEASE FILL IN ALL ANSWERS COMPLETELY

A. PERSONAL

1) Are you of 18 years of age or older? *

YES NO

2) What was the date of your last Physical Examination and TB Test? *

3) Have you ever been employed under a different name? *

YES NO

If YES, Please list name(s) *

B. POSITION

4) What is the position you are applying for? *

5) Do you have a salary requirement? (hourly, monthly, annually) *

6) Do you have any limitations to the days or hours you can work? (full-time or part-time) *

7) How soon would you be able to start working for Greenacre Homes & School? *

C. PREVIOUS EMPLOYMENT AND REFERENCES

(LIST MOST RECENT EXPERIENCE FIRST. AT LEAST TWO EMPLOYMENT REFERENCES ARE NEEDED)

1) Company Name and Type of Business *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Dates of Employment *

Supervisor's Name *

Your Job Title *

Responsibilities *

Salary History *

Reason(s) For Leaving *

2) Company Name and Type of Business *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Dates of Employment *

Supervisor's Name *

Your Job Title *

Responsibilities *

Salary History *

Reason(s) For Leaving *

3) Company Name and Type of Business *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Dates of Employment *

Supervisor's Name *

Your Job Title *

Responsibilities *

Salary History *

Reason(s) For Leaving *

D. EDUCATION AND TRAINING

NAME & LOCATION OF SCHOOL

High School *

Major *

# of Years Completed *

# of Units Completed *

GED, Diploma, Degree or Certificate *

Date Completed *

NAME & LOCATION OF SCHOOL

College *

Major *

# of Years Completed *

# of Units Completed *

GED, Diploma, Degree or Certificate *

Date Completed *

NAME & LOCATION OF SCHOOL

College *

Major *

# of Years Completed *

# of Units Completed *

GED, Diploma, Degree or Certificate *

Date Completed *

NAME & LOCATION OF SCHOOL

College *

Major *

# of Years Completed *

# of Units Completed *

GED, Diploma, Degree or Certificate *

Date Completed *

NAME & LOCATION OF SCHOOL

Vocational School *

Major *

# of Years Completed *

# of Units Completed *

GED, Diploma, Degree or Certificate *

Date Completed *

NAME & LOCATION OF SCHOOL

Other School *

Major *

# of Years Completed *

# of Units Completed *

GED, Diploma, Degree or Certificate *

Date Completed *

10) Describe how your college experiences relate to the job for which you are applying for. Include any extracurricular activities or interests you feel should be considered as part of your application *

E. PROFESSIONAL AND TECHNICAL QUALIFICATIONS

List licenses or certificates of competence held *

Name of professional associations of which you are a member *

11) Describe how your training experiences or associations memberships relate to the position you are applying for. Include any extracurricular activities or interests you feel should be considered as a part of your application *

F. OTHER INFORMATION

12) Have you ever been arrested? *

YES NO

13) Have you ever been convicted of a misdemeanor? *

YES NO

14) Have you ever been convicted of a felony? *

YES NO

15) Have you ever been convicted of a DUI? *

YES NO

16) Do you possess a valid California Driver's License? *

YES NO

17) Do you possess a California Driver's License in good standing? *

YES NO

17a) Will your DMV report reveal a DUI or points? *

YES NO

APPLICANT'S CERTIFICATION

I certify that to the best of my knowledge the above statements, made willingly by me are correct. It is agreed that any false statements made as part of this application will result in termination of my employment.

Name *

First

Last

Date *

Upload Resume/Cover Letter *

Max file size: 20MB

Submit

Administration
438 Eddie Lane
Sebastopol, CA 95472
(707) 823-8722
www.greenacrehomes.org

School
7590 Atkinson Road
Sebastopol, CA 95472
(707) 829-1366

Greenacre Homes & School Employment Application438 Eddie LaneSebastopol, CA 95472(707) 823-8722

A. PERSONAL

B. POSITION

C. PREVIOUS EMPLOYMENT AND REFERENCES

D. EDUCATION AND TRAINING

E. PROFESSIONAL AND TECHNICAL QUALIFICATIONS

F. OTHER INFORMATION

APPLICANT'S CERTIFICATION

Greenacre Homes & School Employment Application
438 Eddie Lane
Sebastopol, CA 95472
(707) 823-8722