UPWARD BOUND SUMMER INSTRUCTOR APPLICATION
Personal Information:
Last Name
First Name
Middle Name or Initial
Date of Birth
Present Address (Number, Street, Date Residence
City
State
Zip
Code
Area Code & Phone Number
( )
Permanent Address (if different from above)
City
State
Zip
Code
Area Code & Phone Number
( )
Email Address
Social Security #
Education
School or
Institution
Name and Location
No. of
Years
Completed
Graduated
Course of
Study
Degree/Certificate
Junior College (if
applicable)
Other College or
University
Graduate School
Business, Trade, or
Service Schools
Work Experience (paid or volunteer):
Name of Employer
Title or Position
Description of duties/role:
Address
City
State
Zip Code
Employment Dates (Month & Year)
From: To:
Name and Title of Immediate Supervisor
Area Code & Phone Number
( ) -
Name of Employer
Title or Position
Description of duties/role:
Address
City
State
Zip Code
Employment Dates (Month & Year)
From: To:
Name and Title of Immediate Supervisor
Area Code & Phone Number
( ) -
Name of Employer
Title or Position
Description of duties/role:
Address
City
State
Zip Code
Employment Dates (Month & Year)
From: To:
Name and Title of Immediate Supervisor
Area Code & Phone Number
( ) -
Name of Employer
Title or Position
Description of duties/role:
Address
City
State
Zip Code
Employment Dates (Month & Year)
From: To:
Name and Title of Immediate Supervisor
Area Code & Phone Number
( ) -
Training/Certification
Check courses taken for special skills, current certification or leadership. Indicate expiration date. (Proof of certification will be required.)
First Aid ____
E
xpires:
CPR ____
E
xpires:
Life Guarding Experience ____
E
xpires:
Teaching Certificate ____
E
xpires:
Are 21 or older AND possess a valid driver’s license. (This is not a requirement for employment; however, some staff duties may include driving
rental vehicles.) ______
I
f so, are you available to drive? ___Yes ___No Driver's license #__________
_________ State
Expiration Date:
DMV records will be obtained and reviewed for employees for whom driving is a job responsibility.
References
List 3 people NOT related to you who can attest to your qualifications for the position for which you are applying. Include one of your previously listed
employers. A minimum of 2 references are required in order to complete the hiring process for new staff members, and 1 reference is required for
returning staff..
Name
Profession
Area Code & Phone Number
Business or Home Address / Email
Bus. ( ) -
Home ( ) -
Address:
Email:
Bus. ( ) -
H
ome ( ) -
Address:
E
mail:
Bus. ( ) -
H
ome ( ) -
Address:
E
mail:
I
hereby authorize College of the Redwoods to thoroughly investigate my references, work record, education and other matters related to my
suitability for employment and, further, authorize the references I have listed to disclose to College of the Redwoods any and all letters, reports and
other information related to my work records, without giving prior notice of such disclosure. In addition, I hereby release College of the Redwoods,
my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out
of or in any way related to such investigation or disclosure.
(Check all that apply) Present Employer
Previous Employers
References Listed Signature
Date
Please email your application, resume, cover letter, and your course proposal to
katy-keyser@redwoods.edu