Employment Form

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Personal Information

Name *

First

Last

Address

Address *

Address Line 1

City

State

Zip Code

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Cell Phone *

Primary Email *

Daytime Phone *

Secondary Email *

Drivers License

Driver's License #

Driver's License State

Driver's License Expiration Date

Are you bilingual? *

If Yes, what language(s)?

Preferences

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Instructional Programs - Please select the program(s) of interest. *

Jump Into English for Parents
Jump Into English for Students
Jump Into Math for Students

Employment Position - Please select the position(s) of interest. *

Instructor
Para Instructor
Program Coordinator
Program Administrator
Site Liaison
Other

If Other, Please Explain

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District *

School

Grade

Employment Records

Have you ever been employed by JIM Enterprises Inc.? *

Current Employer

Current School

Current Supervisor Name

Current Supervisor Email

Current Position

Current Grade Level

Current Supervisor Phone

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How long have you been employed?

May we contact?

Previous Employer

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Previous Employer

Previous School

Previous Supervisor Name

Previous Supervisor Email

Previous Position

Previous Grade Level

Previous Supervisor Phone

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How long were you employed?

May we contact?

Reason for Leaving

Training, Credentials, Education and References

Educational Training Background – Please list any specialized educational training , certificates and/ or completed courses

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College or University Attended (name)

Do you hold a valid California Teaching Credential? *

Have you ever been convicted of a felony? *

Degree

PhD
MS/MA
BS/BA
AA/EQUIVALENT
National Board Certified
Specialist
ELL/ESOL Certified
ESE Certified
GT Certified
Reading Endorsement

References

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Reference 1 *

Reference 1 Phone *

Reference 1 Email *

Reference 2 *

Reference 2 Phone *

Reference 2 Email *

Referral

How did you hear about this position?

If you were referred to this position by someone, please note it below.

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Name

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Terms & Conditions

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? *

If no, describe the functions that cannot be performed:

Paragraph Text *

Note: We comply with Federal, State and Local regulations and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. New Hires may be subject to passing a medical examination, and skill and agility tests.

Terms & Conditions *

By typing my name in the signature text box below and submitting this form, I agree that all information is true and accurate. I understand that should I provide any false information during the job selection process, including information in this job application, JIM Enterprises, Inc. may decline to hire me, withdraw any job offer, and/or terminate my employment. It is the policy of JIM Enterprises, Inc. to provide equal employment opportunities to all qualified persons without regard to race, national origin, sex, sexual orientation, age, religion, physical or mental disability, veteran status, or other protected classifications. Employment with JIM Enterprises, Inc. is "At-Will", which means that either JIM Enterprises, Inc. or I may terminate my employment at any time, with or without any notice and with or without any reason. In addition, I consent to have my fingerprint and background clearance completed by JIM Enterprises, Inc. and understand that should I not receive the foregoing clearances, I may be subject to non-hire or dismissal.

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Name *

Date *

Personal Information

Address

Preferences

Employment Records

Current Employer

Previous Employer

Training, Credentials, Education and References

References

Referral

Terms & Conditions

Email:

Phone: