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 requested,
you may lose consideration for employment.
PERSONAL INFORMATION
Name: (Last name first)
  
Mailing Address:
 City:
 State:
 Zip Code:
Phone Number:
 Email Address:
Are you 18 yrs or older? Yes No
EMPLOYMENT INFORMATION
Desired Position:
   Date You
Can Start:
   Desired
Salary:
   Are You Currently
Employed?
Yes
No		   If so, May We Contact
Your Current Employer?
Yes
No
What days are you available?

Mon

Tue

Wed

Thu

Fri

Sat

Sun

 
Desired Employment:

Full-Time Part-time 		What hours are
you available?
Have you ever worked for Tumbleweed? Yes No Where?
 When?
Reason for leaving?
Name of last supervisor at this company:
Who referred you to this company?

Employment Agency

  Newspaper Ad   Friend   College Placement
                     
Internet Posting   Walk-In   Other      
WORK EXPERIENCE
Present or last Employer: Name:
  Address:
Job Title:
   Start Date:   Salary:
  End Date:   Hrs Per Week:
         
Supervisors Name:
   Supervisors Phone #:
   May We Contact Your Current Supervisor?
Yes No
 
Describe Your Duties and Accomplishments

If we need to contact your supervisor before making an offer, we will contact you first.
WORK EXPERIENCE
Job Title:
   Start Date:   Salary:
  End Date:   Hrs Per Week:
         
Supervisors Name:
   Supervisors Phone #:
   Reason For Leaving:
 
Describe Your Duties and Accomplishments
WORK EXPERIENCE
Job Title:
   Start Date:   Salary:
  
  End Date:   Hrs Per Week:
  
         
Supervisors Name:
   Supervisors Phone #:
   Reason For Leaving:
Describe Your Duties and Accomplishments
WORK EXPERIENCE
Job Title:
   Start Date:   Salary:
  
  End Date:   Hrs Per Week:
  
         
Supervisors Name:
   Supervisors Phone #:
   Reason For Leaving:
 
Describe Your Duties and Accomplishments
EDUCATION
Mark highest
level completed:		   High School   Associate   Bachelor   Master   Doctoral
 
Name of School Location of School Years
Attended 		Did You
Graduate?		 Subjects Studied/
Degree Received
High School:

Yes
No
College:

Yes
No
Trade or Business School:

Yes
No
OTHER QUALIFICATIONS

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.
REFERENCES

Three Persons Who You Are Not Related To, Whom You Have Known At Least One Year:

Name Address Business Phone
Number 		Years
Acquainted
 

HAVE YOU BEEN CONVICTED OF A FELONY OR MISDEMEANOR? Yes No

If Yes, Please Explain:

AUTHORIZATION
“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 REPRESENTATIVE”.



 

By 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 POSITION(S) ABOVE
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 position.
2. How would you respond to a youth who used abusive language?
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.