Application for Employment

Check one:

New ApplicantRe-employment Applicant

Position you are applying for:*

Name*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Address*

Street

Street Address Line 2

City

State/Zip

Will you be 18 or older by June 1st?*

YesNo

Did you serve in an Americorps, Peace Corps, or another national service program?*

YesNo

Name of business:*

Your title or position:*

Address*

address

Street Address Line 2

city/state/zip

Starting date:*

Date

Ending date:*

Date

Ending salary:*

Name and title of immediate supervisor:*

Supervisor Phone Number*

Please enter a valid phone number.

Supervisor Email*

example@example.com

Reason for leaving:*

Description of duties:*

Name of business:

Your title or position:

Address

address

Street Address Line 2

city/state/zip

Starting date:

Date

Ending date:

Date

Ending salary:

Name and title of immediate supervisor:

Supervisor Phone Number

Please enter a valid phone number.

Supervisor Email

example@example.com

Reason for leaving:

Description of duties:

Highest level of education you've completed *

Describe any specialized training, apprenticeship, skills and extra-curricular activities:*

State any additional information you feel may be helpful to us in considering your application:*

Languages spoken:*

Training*

	Sponsoring Organization and Location	Name of course, seminar, etc	CEUs	# Honors	Dates

Volunteer Activities*

	Organization	Position / offices held	Location	No. of years

First time applicants: Please provide a detailed description of your work with children, the community, or school as it relates to the job you are seeking. *

Tell us why you are interested in Girl Scouts of Southern Arizona and how you believe you will excel in the job you are seeking. *

These are our Girl Scouts of Southern Arizona Core Values:

1. Our Girl Scouts first

2. Be the voice, live the mission

3. Welcome opportunities for growth, innovation, and active listening

4. Honor, embrace, and design for diversity

5. Empower ourselves, each other, and those we serve.

Which one of these core values resonates with you most and why?*

What is your desired salary or hourly rate for this position?*

Reference #1 Name:*

Reference #1 Profession:*

Reference #1 Phone:*

Reference #1 Email *

example@example.com

Reference #2 Name:*

Reference #2 Profession:*

Reference #2 Phone:*

Reference #2 Email*

example@example.com

Reference #3 Name:*

Reference #3 Profession:*

Reference #3 Phone:*

Reference #3 Email*

example@example.com

I hereby authorize Girl Scouts of Southern Arizona, Inc. to check all my educational references and the personal and employment references as indicated:*

Present employerPresent employer after accepting positionPrevious employersReferences

Are you able to perform the essential functions of the position for which you are applying, with or without reasonable accommodation? (see job descriptions here: www.girlscoutssoaz.org/employment)*

YesNo

Do you have a valid Arizona driver’s license?*

YesNo

Has your driver’s license been suspended within the past 6 months?*

YesNo

Have you ever been convicted of a crime? If yes, please state offense, date and location (a conviction record will not necessarily be cause for disqualification):*

YesNo

Offense and Location:

Date of offense:

Date

I understand that this employment application and any other Girl Scout documents are not contracts of employment, and that any individual who is hired may voluntarily leave employment and may be terminated by Girl Scouts of Southern Ariziona, Inc. at any time. I understand that any oral or written statement to the contrary are hereby expressly disavowed and should not be relied upon by any prospective or existing employee. I authorize investigation of all information contained herein and specifi cally authorize the employers and references to give you any and all information concerning me, and by doing so, release all persons from any liability for providing this information to Girl Scouts of Southern Arizona, Inc., and the use of such information by Girl Scouts of Southern Arizona, Inc. in connection with this application for employment. I certify that my answers to the preceding questions are true and complete, and that I have not knowingly withheld any information which might, if disclosed, affect my application unfavorably. I understand that misrepresentation or omission of facts on this application will be cause for rejection of this application or dismissal after employment and that employment is subject to verifi cation of references and satisfactory completion of an introductory period. Note: For your convenience, this form will accept digital signatures so you can return it by e-mail. If you need a digital signature ID to sign this form with, please click here girlscoutssoaz.org/signatures for our step-by-step guide to creating your own.

signature*

date*

Date

Application for Employment

Employment History

Education

Statements

References

Authorization