BSMA Application

Applicant Information

Full Name *

Street Address *

Apartment/Unit #

City, State and Zip Code *

Phone Number *

E-Mail *

How did you hear about us?

Job Information

Position Applied ForInstructorFront Desk Staff

Desired Pay Rate Per Hour

Desired Number of Hours

Preferred Start Date

Are you over 18 years of age? If not, you are required to obtain working papers.YesNo

Are you currently employed?YesNo

May we contact your current employer?YesNo

Do you have your own car or dependable way to work?YesNo

Have you ever been convicted of a felony?YesNo

Education

High School *

Attended Years

Did you graduate?YesNo

College

Attended Years

Did you graduate?YesNo

Degree

Other

Attended Years

Did you graduate?YesNo

Degree

Personal Qualities

Describe personal athletic and/or experience working with children that you have which will enable you to perform the job you are applying for. Please be thorough.

Previous Employment

Company 1

Phone

Address

Supervisor

Job Title

Responsibilities

Date Started

Date Left

Reason for leaving

May we contact this employer for a reference?YesNo

Company 2

Phone

Address

Supervisor

Job Title

Responsibilities

Date Started

Date Left

Reason for leaving

May we contact this employer for a reference?YesNo

Company 3

Phone

Address

Supervisor

Job Title

Responsibilities

Date Started

Date Left

Reason for leaving

May we contact this employer for a reference?YesNo

References

Full Name *

Relationship *

Company *

Phone *

Email *

Name *

Relationship *

Company *

Phone *

Email *

Name *

Relationship *

Company *

Phone *

Email *

0 + 3 = ?Please prove that you are human by solving the equation *