Investing in our future
Online Employment Application Form
Tumbleweed Center For Youth Development is
An Equal Opportunity Employer
If your application does not provide the information
you may lose consideration for employment.
Top of Form
Name: (Last name
Are you 18 yrs or
Are You Currently
May We Contact Your
What days are you available?
What hours are you available?
Have you ever worked for
Reason for leaving?
Name of last supervisor at this company:
referred you to this company?
or last Employer:
Hours Per Week:
Supervisors Phone Number:
May We Contact Your Current Supervisor?
If we need to contact your supervisor before
making an offer, we will contact you first.
Describe Your Duties and Accomplishments
Employer's Name and Address:
Reason For Leaving:
highest level completed:
Name of School
Location of School
Did You Graduate?
Subjects Studied/Degree Received
Trade or Business School:
Job-related training courses (give title and
year). Job related skills (other languages,
computer software/hardware, typing etc.).
Job-related certificates and licenses
(current only). Job-related honors, awards,
and special accomplishments (publications,
memberships in professional/honor societies,
leadership activities, public speaking, and
performance awards. Give dates, but do not
attach documents unless requested.
Three Persons Who You Are Not Related To, Whom You Have
Known At Least One Year
HAVE YOU BEEN CONVICTED OF A FELONY OR
If Yes, Please Explain:
“I CERTIFY THAT THE FACTS CONTAINED IN THIS
APPLICATION ARE TRUE AND COMPLETE TO THE
BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF
EMPLOYED; FALSIFIED STATEMENTS ON THIS
APPLICATION SHALL BE GROUNDS FOR DISMISSAL.
I AUTHORIZE INVESTIGATION OF ALL STATEMENTS
CONTAINED HEREIN AND THE REFERENCES AND
EMPLOYERS LISTED ABOVE TO GIVE YOU ANY AND
ALL INFORMATION CONCERNING MY PREVIOUS
EMPLOYMENT AND ANY PERTINENT INFORMATION
THEY MAY HAVE, PERSONAL OR OTHERWISE AND
RELEASE THE COMPANY FROM ALL LIABILITY FOR
ANY DAMAGE THAT MAY RESULT FROM UTILIZATION
OF SUCH INFORMATION.
I ALSO UNDERSTAND AND AGREE THAT NO
REPRESENTATIVE OF THE COMPANY HAS ANY
AUTHORITY TO ENTER INTO ANY AGREEMENT FOR
EMPLOYMENT FOR ANY SPECIFIED PERIOD OF
TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO
THE FOREGOING, UNLESS IT IS IN WRITING AND
SIGNED BY AN AUTHORIZED COMPANY
Checking This Box, You Signify
That You Are in Agreement With
The Authorization Clause Above.
You Also Agree That This Check
Mark Is Legal and Binding in
Place of Your Signature.
YOUTH CARE/OUTREACH WORKER SUPPLEMENTAL QUESTIONNAIRE
*COMPLETE THIS SECTION ONLY IF YOU ARE APPLYING FOR THE
1. Please outline your experience of working
with (supervising) youth with a brief
explanation as to your reason for applying
for the Youth Care or Outreach Worker
2. How would you respond to a youth who used
3. What can you contribute to establish a
positive working environment at Tumbleweed?
4. What qualities do you have that make you
an effective team player?
5. Are you familiar with the Youth
Development Model? If so, briefly explain.
Tumbleweed Center For Youth Development - 1419
N. 3rd St. #102 Phoenix, Arizona 85004
Phone: 602.271.9904 | 24-hour crisis hotline: 602.841.5799 | Toll free number: 1.866.SAFE703