Application for employment

Name*

First Last

Home Address

Street Address City State ZIP Code

School Address (if applicable)

Street Address City State ZIP Code

Your Email Address

Your Phone Number

Your Social Security Number (xxx-xxx-xxxx)

Area(s) of Competency (Check All That Apply)

Microsoft Office Software (2007 or Later)

Word
Publisher
Powerpoint
Excel
Outlook

I am applying for one of the following:

Summer 2013 Internship
Fall 2013 Internship
Winter 2014 Internship
Spring 2014 Internship
Academic Credit Internship

I am willing to consider:

Paid Position
Unpaid Position

Employment

Full Time
Part Time

Check All That Apply

How did you hear about us?

How my we contact you?

E-mail
Phone

If you are under 18, can you furnish a work permit?

Yes
No

Have you applied to work for Dutch Springs or Northstar in the past?

Yes
No

If Yes, When?

Have you ever worked for Dutch Springs or Northstar in the past?

Yes
No

If Yes, When?

Are you legally eligible for employment in the United States?

Yes
No

First day you are able to begin work?

If currently employed, last day at your current job?

Are you currently laid off and subject to recall?

Yes
No

Have you ever been bonded?

Yes
No

Have you been convicted of a felony in the last seven (7) years?

Yes
No

If yes, please explain:

Work and Volunteer History

Starting with your current or most previous experience, fill in the fields.

Organization / Employer

Job Type

Full Time
Part Time

Telephone

Address

Street Address City State ZIP Code

Volunteer / Job Title

Supervisor's Name & Title

Reason for Leaving

May we contact this employeer for reference?

Yes
No

Dates Employeed

From

To

Hourly Rate

Summarize duties performed and job responsibilities

Organization / Employer

Job Type

Full Time
Part Time

Telephone

Address

Street Address City State ZIP Code

Volunteer / Job Title

Supervisor's Name & Title

Reason for Leaving

May we contact this employeer for reference?

Yes
No

Dates Employeed

From

To

Hourly Rate

Summarize duties performed and job responsibilities

Educational Background

School

Highest Grade Completed

Degree / Diploma / Concentration

GPA / Class Rank

Major

Minor

School

Highest Grade Completed

Degree / Diploma / Concentration

GPA / Class Rank

Major

Minor

List any foreign languages and check the box that best describes your aptitude.

Language

Aptitude

Read & Write
Read & Speak
Read Only
Write Only

Language

Aptitude

Read & Write
Read & Speak
Read Only
Write Only

Please List all certifications (i.e. Life Guard, CPR, First aid, etc.)

References

List at least three (3) academic / work / volunteer references who are not related to you and are not previous supervisors. If not applicable, list three (3) school or personal references who are not related to you.

Name

First Last

Phone

Email (if known)

Years Known

Capacity Known

Name

First Last

Phone

Email (if known)

Years Known

Capacity Known

Name

First Last

Phone

Email (if known)

Years Known

Capacity Known

List professional, trade, civic, academic or other associations and any offices held. Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.

Organization

Offices Held

Organization

Offices Held

Organization

Offices Held

Special Acomplisments

List special accomplishments, publications, awards. Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.

List any additional information you would like us to consider.

Disclosure

Please read the following:

It is understood and agreed upon that any misrepresentation by me in this online application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed.
I give the Employer (Northstar Team Development) the right to investigate all references and secure additional information about me, if job related. I hereby release from liability the Employer (Northstar Team Development) and its representatives for seeking such information and all persons, corporations, or organizations for furnishing such information.
The Employer (Northstar Team Development) is an Equal Opportunity Employer. We do not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state or federal law.
I understand that just as I am free to resign at any time, Northstar Team Development reserves the right to terminate my employment at any time, with or without prior notice. I understand that no representative of Northstar Team Development has the authority to make any assurances to the contrary.

Electronic Signature*

Type in your full name

Date

NorthStar Adventure

at Dutch Springs

Reach New Heights

Achieve Goals Together

Challenge Yourself

Employment / Internship Application for Northstar Adventure

Work and Volunteer History

Educational Background

References

Disclosure

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