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WHO WE ARE
PROGRAMS
GiftedAcademy
GiftedImpact
GiftedSummer
GiftedReach
ImpactReport
THE VILLAGE
Our Culture + Space
Supporters
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Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
*
Phone
*
(###)
###
####
Position
*
GiftedProducer - After School Artistic Instructor
GiftedImpact Site Supervisor
Date of Birth
*
MM
DD
YYYY
Have you ever been convicted of a crime, pled no contest, or had adjudication withheld?
*
Yes
No
If yes, please provide a date, location, charges and a complete explanation of all offenses.
EMPLOYMENT INFORMATION
Preferred Job Status
*
Part Time
Seasonal
As Needed
Volunteer
Have you previously been employed at TheGifted Arts?
*
Yes
No
Have you previously volunteered at TheGifted Arts?
*
Yes
No
Have you ever been a member of GiftedAcademy?
*
Yes
No
EDUCATION
High School Name
Location
(City, State)
Graduate
--
Yes
No
# of Years Completed
*
College School Name
Location
(City, State)
Graduate
--
No
Yes
# of Years Completed
Degree/Major
Tech/Trade?Post College Name
Location
(City, State)
Graduate
--
Yes
No
Number
Degree/Major
WORK EXPERIENCE
Employer
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Start Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Job Title
Supervisor's Name
May we contact
Yes
No
Employer
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
State Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Job Title
Supervisor's Name
May we contact?
*
Yes
No
Employer
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Start Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Job Title
Supervisor's Name
May we contact?
Yes
No
REFERENCES
Please list any additional work-related or school/volunteer- related references that we may contact.
Name
Relationship
Phone
(###)
###
####
Name
Relationship
Phone
(###)
###
####
Thank you for your submission. We will review your application and contact you soon.