Name *

First Name

Last Name

Other names by which you have been known

First Name

Last Name

Phone

(###)

###

####

Permanent Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Previous Address (If at current address less than 7 years)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

If you are not a citizen of the United States, are you eligible to work in the U.S. and would you be able to provide the necessary documents of proof of the legal right to work upon hire? *

Yes

No

The Age Discrimination in Employment Act of 1967, prohibits discrimination on the basis of age with respect to individuals who are at least 40, but less than 70 years of age. Are you at least 18 years of age? *

Yes

No

Have you ever been convicted of a crime? *

A conviction record will not necessarily be a bar to employment. Factors such as age at the time of the offense, type of offense and relevance to the job for which you are applying, seriousness and nature of the offense and rehabilitation will be taken into account.

Yes

No

Days/Hours available to work *

No preference

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Are you available to work mornings? *

Yes

No

Are you available to work evenings? *

Yes

No

As a School of Play employee, Therapists are required to drive to and from their clients, as it plays a mandatory part in the line of work. Will this be a challenge for you? *

Yes

No

Education and Training Indicate last level completed *

High School

College/University

Graduate School

Company address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Company phone

(###)

###

####

May we contact your employer?

Yes

No

Date of employment from

MM

DD

YYYY

Date of employment to

MM

DD

YYYY

Company address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Company phone

(###)

###

####

May we contact your employer?

Yes

No

Date of employment from

MM

DD

YYYY

Date of employment to

MM

DD

YYYY

Name *

First Name

Last Name

Phone *

(###)

###

####

Name *

First Name

Last Name

Phone *

(###)

###

####

Name *

First Name

Last Name

Phone *

(###)

###

####