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Phone: 914.949.2636
Fax: 914.949.0955
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Purchase Community House
Employment Application
Please fill out the application form below and click "Submit Application" at the bottom of the page. If you would prefer to fill out the application by hand, you can
download the application here
.
First Name:
Last Name:
Street Address:
City:
State:
Zip:
Home Phone:
Cellphone:
Birthdate:
Present Occupation:
Gender
Select Gender
MALE
FEMALE
Email Address:
Work Email Address:
Educational Background
Education
Name of School
Current Year or
Last Year Completed
Did You Graduate?
Year Graduated
Degree and/or Major
High School
1
2
3
4
YES
NO
College
1
2
3
4
YES
NO
Post College
1
2
3
4
YES
NO
Trade School
1
2
3
4
YES
NO
Work Experience (List PAID EXPERIENCE in order of most recent position.)
Type of Work
Organization
Dates
Employer
Phone
Volunteer Experience (List any VOLUNTEER EXPERIENCE you have had.)
1.
2.
3.
Experience with Children (What related experience with children have you had? Teaching, babysitting, etc. (include ages & gender)
Certifications - Please indicate any CURRENT certifications you have below.
Child Care Certifications
American Red Cross/YMCA Certifications
Teacher Certification
Lifeguard Training
Responding to Emergencies
CDA Certification
Lifeguard Training Instructor
Community CPR
Associates Degree
Water Safety Instructor (WSI)
CPR for the Professional Rescuer
Other (specify)
Standard First Aid
Other (specify)
Character and References - List 3 people who know of your work such as teachers, employers, etc. No family members, please.
Name
Address
Phone Number
1.
2.
3.
Have you ever been charged, either criminally or civally, with sexual abuse, sexual harassment or discrimination?
YES
NO
Have you ever been convicted of a felony?
YES
NO
If you answered YES to either of the last two questions, please explain.
Activities - Select "LIKE" next to the activites that you like to do. Select "TEACH" next to activities that you could teach or help teach.
LIKE
TEACH
Arts & Crafts
LIKE
TEACH
Science
LIKE
TEACH
Music
LIKE
TEACH
Nature
LIKE
TEACH
Cooking
LIKE
TEACH
Sports
LIKE
TEACH
Singing
LIKE
TEACH
Dance
LIKE
TEACH
Gymnastics
LIKE
TEACH
Photography
LIKE
TEACH
Improv/Theatre
LIKE
TEACH
Carpentry
Other:
Are you available to work weekday mornings?
The following question is to prevent spam and must be answered correctly to submit the application. The color of a ripe pumpkin is...?