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 (REQUIRED)
Name: (Last name first)
  
Mailing Address:
 City:
 State:
 Zip Code:
Phone Number:
 Email Address:
Are you 18 yrs or older?



EMPLOYMENT INFORMATION (REQUIRED)


Desired Position:
   Date Available:
   Desired Salary:
   Currently Employed?
   May We Contact Current Employer?
What days are you available?

 
Desired Employment:


 What hours are you available?
 
Have you ever worked for Tumbleweed?
If So, Where?

When?
Reason for leaving?
Name of last supervisor at this company:
Who referred you to Tumbleweed?





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?
 
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 (REQUIRED)
Mark highest
level completed:
Name of School Location of School Years
Attended 		Did You
Graduate?		 Subjects Studied/
Degree Received
High School:



College:



Trade or Business School:






OTHER QUALIFICATIONS

Job-related tr aining 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 (REQUIRED)

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?

If Yes, Please Explain:





AUTHORIZATION (REQUIRED)
“I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE tr UE 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 CONtr ARY 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/OUEACH 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 Outr each Worker position.
2. How would you respond to a youth who used abusive language?
3. What can you contr ibute 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.