Join Our Team – Stafford Junction

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Job Application Please print clearly or type Date: ___________________ Name the position for which you are applying: __________________________________________________ Name: _________________________________________________________ DOB: ____________________ Address: _______________________________________City:__________________, VA Zip: ___________ Phone (H): ________________________ (W): ________________________(cell): _____________________ E-mail:__________________________________________________________________________________ Emergency Contact: ___________________________ Relationship: _________________Phone:__________ Are you seeking to fulfill an internship or class requirement? _____Yes _____No If yes, please provide name of institution, course name, hours required, and deadline for hours: _______________________________________________________________________________________ SKILLS & EXPERIENCE What is your educational background? _______________________________________________________ What is your occupation? __________________________________________________________________ What languages can you speak, read, or write fluently? __________________________________________ Do you have any past or present experience working with youth? If yes, please describe: _______________ _______________________________________________________________________________________ What types of transportation do you use? ______________________________________________________ Please check the area(s) that interest you. Check as many or as few as you like. I would enjoy: ___ Tutoring ___ Sports/Coaching ___ Music ___ Arts & Crafts ___ Listening to a child read ___ Assisting with Fundraising ___ Mentoring Teens ___ Office & Clerical work ___ Field Trips ___ Preparing/Serving Food ___ Leading games ___ Cleaning ___ Serving on a committee ___ Advertising Are there any physical limitations or are you under any course of treatment which might limit your ability to perform certain types of work? ______________________________________________________________ EMPLOYMENT HISTORY Present Or Last Position: Employer: ________________________________________________________________________________ Address: _______________________________________City:__________________, VA Zip:____________ Supervisor: ______________________________ Phone: ________________ Email:_____________________ Position Title: _______________________________________ From: ______________ To: ______________ Responsibilities:___________________________________________________________________________ _________________________________________________________________________________________ Salary: ____________________ Reason for Leaving: _____________________________________________ =========== Previous Position: Employer: ________________________________________________________________________________ Address: _______________________________________City:__________________, VA Zip:____________ Supervisor: ______________________________ Phone: ________________ Email:_____________________ Position Title: _______________________________________ From: ______________ To: ______________ Responsibilities:___________________________________________________________________________ _________________________________________________________________________________________ Salary: ____________________ Reason for Leaving: _____________________________________________ May We Contact Your Present Employer? Yes _____ No _____ REFERENCES Please list two non-related people who can attest to your character, skill and dependability. Name: _________________________________________________ Phone: ___________________________ Address: _______________________________________________ Relation: __________________________ Name: ________________________________________ Phone: ___________________________ Address: ______________________________________ Relation: __________________________ LEGAL Please circle the applicable response. Existence of criminal conviction may or may not, depending upon the circumstances, disqualify you from consideration. However, any intentional misrepresentation or omission will disqualify you. Do not include minor traffic violations. 1. Do you currently use illegal drugs? Yes No 2. Have you ever been convicted of a criminal offense, other than minor traffic violations? Yes No 3. Have you ever been convicted of child abuse or neglect or is there appending criminal charge against you for child abuse or neglect? Yes No 4. Has your driver’s license been suspended or revoked? Yes No 5. Are there any other facts or circumstances involving you or your background that would call into question your being entrusted with the supervision, guidance and care of young people? Yes No Please use the space below to explain any “yes” responses. _________________________________________________________________________________________ _________________________________________________________________________________________ COMMUNITY SERVICE Describe how you have reached out to help others and/or how you have been involved in your own community. Elaborate on why you decided to serve or get involved, and what you received in return—that is, what you learned or how it made you feel. _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ MOTIVATIONAL STATEMENT Why do you want to work with Stafford Junction? What could you contribute to the programs? What do you hope to gain from serving in this position? _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ UNDERSTANDING AND AUTHORIZATION I certify that all the answers on the application and any attachments are true and complete to the best of my knowledge. I also certify that I have not withheld any pertinent information. I agree that in the course of considering my application, you may inquire to verify information considering my background. I specifically authorize you to investigate all statements in this application. I authorize educational institutions, employers and references listed above to give you any and all information concerning my education, employment, and fitness to work with children and young people. I further agree to release and hold harmless Stafford Junction, institutions and references listed above and any law enforcement agency, from all liability and any damage that may result from furnishing this information to you. Signature: _________________________________________________Date:_____________ Return to: Stafford Junction PO Box 5405 Fredericksburg, VA 22403 791 Truslow Road Fredericksburg, VA 22406

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Stafford Junction is always searching for passionate people that want to affect real and lasting change in Stafford, VA. If you are interested in being part of our team, please send your resume to carrieevans@staffordjunction.org.

Open Positions:

If interested please forward your resume to the executive director at: carrieevans@staffordjunction.org