Application For Seasonal Employment Form
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4HR Approval/DQ: ___________________
APPLICATION FOR SEASONAL EMPLOYMENT
ANSWER ALL QUESTIONS FULLY AND CAREFULLY. Print in ink or use typewriter. Attach additional sheets if necessary in order to give
complete and detailed information. All statements are subject to verification.
Can work from:
/
/
to
/
/
Title of Position you are applying for:
Agency or Facility at which you wish to work (please list all locations):
1.
Name:
2.
Email Address:
Last
First
M.I.
Permanent Address:
Street Address
City or Post Office Box
State
Zip
Local Address (if different):
Telephone Number:
Home: (
)
Cell: (
)
3. If under 18, please enter date of birth:
/
/
4.
Check appropriate answer for each question:
A.
Were you ever dismissed or discharged from any employment for reasons other than lack of work or funds?
Yes
No
B.
Did you ever resign from any employment rather than face dismissal?
Yes
No
C.
Have you ever been convicted of any crime (felony or misdemeanor)?
Yes
No
D.
Are you now under charges for any crime?
Yes
No
If you answered “YES” to any of the questions above, give specifics under REMARKS on page 2 of this application. None of the above circumstances represents an automatic
bar to employment. Each case is considered and evaluated on individual merits in relation to the duties and responsibilities of the position for which you are applying.
b) If not, do you have the legal right to accept employment in the US?
Yes
No
5.
a) Are you a US citizen?
Yes
No
Have you ever worked for the City of Ithaca, Ithaca City School District or Ithaca Housing Authority?
Yes
No
6.
EDUCATION
7.
Have you graduated from high school?
Yes
No
If yes, give name and location of high school:
If no, do you have a high school equivalency diploma (GED)?
Yes
No
If yes, indicate issuing government authority
Number:
Date of Issue:
If no, give highest grade completed:
If you have attended college, please complete the following:
Name of School and City in
Dates of Attendance
Did You
Type of Course
Number of
Type of
Date Degree
which located
(Month and Year)
Graduate?
or
College
Degree
Rec’d or
________________
Major Subject
Credits
Received
Expected
From
To
Received
College,
University,
Professional
or Technical
School
If the position you are applying for requires a driver’s license, complete this question:
Do you have a valid N.Y.S. motor vehicle operator’s license?
Yes
No
8.
If yes, class:
Expiration Date:
Number:
9.
Please list any certifications (i.e. Lifesaving, CPR, etc.) that you possess. All Lifeguard applicants
fill in & attach copies.
MUST
Name of certification
Agency issuing certification
Date Issued
Expiration Date:
Yes
No
If you are age 14 - 16, would you like us to refer your application to the Youth Employment Service of the Ithaca Youth Bureau?
Would you like us to share your application with other camp directors looking for staff in the Greater Ithaca Area?
Yes
No
Description of Experience:
10.
Length of Employment
Firm Name
Address
City and State
From
To
Earnings
(Circle One)
Duties:
$
/WK/MO/YR
Type of Business
Your Exact Title
Name of Your Supervisor
Supervisor’s Title
No. of hours worked per wk.
over Page 2 of Application
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Parent category: Business