Youth Enrichment League Registration

To apply as a teacher, please complete the following information. Required information is indicated with a (*).

Contact Information

Yes No

Yes No

Areas of Interest

Please mark your areas of interest:

  Lego Chess Guitar or Music (specify below)

 

  Fencing Robotics Magic Other (specify below)

 

  Basketball Soccer Floor Hockey

  Baseball Flag Football Other (specify below)

 


Educational Background

Employment

Yes No

Yes No

Yes No

Yes No

Availability: What time each day are you available?

General Information

  Subjects of special study or research work
 

  Special skills
 

  Activities (exclude organizations, the name of which indicates race, creed, sex, age, marital status, color or nation of origin aof its members)
 

Military Service

Yes No

Former Employment

Former employers (list last three employers starting with the last one first)

Employer 1

 to 

Employer 2

 to 

Employer 3

 to 


References

Give the names of three persons not related to you whom you have known at least one year.

Reference 1

Reference 2

Reference 3

Emergency Contacts

In case of emergency, please notify:

Emergency Contact 1

Emergency Contact 2

Certification

I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY’S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY’S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IT’S PRESIDENT, AND THEN ONLY WHEN IN WRITING AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING.

This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulation and interpretive guidance promulgated by the EEOC on July 26, 1991

Yes

Human Validataion