FORMER EMPLOYEES
(LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH LAST ONE FIRST.)

DATE
MONTH AND YEAR

NAME AND ADDRESS OF EMPLOYER

SALARY

POSITION

REASON FOR LEAVING

FROM:
TO:

 

 

 

 

FROM:
TO:

 

 

 

 

FROM:
TO:

 

 

 

 

FROM:
TO:

 

 

 

 

FROM:
TO:

 

 

 

 

REFERENCES:
(GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN FOR ONE YEAR.)

NAME

ADDRESS

BUSINESS

YEARS
KNOWN

 1

 

 

 

 2

 

 

 

 3

 

 

 

ATTACH A SEPARATE SHEET OF PAPER IF MORE SPACE IS REQUIRED TO ANSWER THE FOLLOWING QUESTIONS:

WHY ARE YOU APPLYING FOR AN INSTRUCTOR'S POSITION AT THE HYC?________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________

WHAT SPECIAL SKILLS AND ATTRIBUTES WILL YOU CONTRIBUTE TO THE HYC JUNIOR PROGRAM?___________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________

The above information is correct and true to the best of my knowledge. I understand that employment is at-will and I am subject to
dismissal or discipline without notice or cause at the discretion of the employer, or Chairman of the Jr. Advisory Committee; that
the employer reserves the right to unilaterally abolish or modify any personnel policy without prior notice; that this application
grants authorization for the employer to make inquiries or obtain information from the applicant's previous employers, schools, and
credit sources; that I am subject to a drug testing policy including random, reasonable suspicion (for cause) and post-accident
testing; and that falsification of any application information is grounds for immediate dismissal.

SIGNATURE____________________________________________________    DATE_______________________