Employee Applications

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Please check the job you are applying for with this application

Program Manager
LITE Coach – Aurora
LITE Coach – Proviso
Program Director

I am seeking

Full time employment
Part time employment
Full or Part time employment

How many hours can you work weekly?

Will you work some evenings?

Yes
No

Please provide a date you are able to start.

Additional Information

Have you ever been employed by this organization in the past?

Yes
No

I certify that I am a U.S. citizen, permanent resident, or a foreign national with authorization to work in the United States

Yes
No

Have you ever been convicted of , or entered a plea of guilty, no contest, or had a withheld judgment to a felony?

Yes
No

If yes, to the question above, please explain.

Do you have a valid driver's license?

Yes
No

Please enter your driver's license number

Issued in what state?

Have you had any accidents during the past three years?

Yes
No

If yes to the question above, please indicate how many.

Selected Value: 0

Have you had any moving violations during the past three years?

Yes
No

If yes to the question above, please indicate how many.

Selected Value: 0

Education History

List the High School you attended

Numbers of years completed.

Please check the appropriate item

High School Diploma
High School Equivalency
Did not graduate

List the college/university you attend(ed)

Numbers of years completed.

Please check appropriate item.

Vocational certificate
Degree
Not completed

Degree received

List the college/university attended.

List the highest degree completed.

Military Information

Have you even been in the Armed Forces?

Yes
No
NA

Date entered

Are you now a member of the National Guard?

Yes
No
NA

Date discharged

List specialty

Employment History

Provide the name of your most recent employer.

Name of your supervisor.

First

Last

Your last job title

Number of hours worked

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Start date.

End date

Starting salary

Final salary

Your last job title

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company

Reason for leaving

May we contact this employer?

Yes
No

Provide the name of employer.

Name of your supervisor.

First

Last

Your last job title

Number of hours worked per week

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Start date.

End date

Starting salary

Final salary

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company

Reason for leaving

May we contact this employer?

Yes
No

Provide the name of employer.

Name of your supervisor.

First

Last

Your last job title

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Number of hours worked per week

Start date.

End date

Starting salary

Final salary

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company

Reason for leaving

May we contact this employer?

Yes
No

Please upload a file of at least 3 professional references.

Click or drag files to this area to upload. You can upload up to 3 files.

Signature and date