Title: Kitchen Assistant

Fields marked with an asterisk (*) must be filled out before submitting.

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First Name
Last name
Email Address

Contact Details

Address
City
Zip Code
Country
Telephone
Have you previously worked for Glen Lake Camp? Yes
No
Dates Worked for Glen Lake
Position
Please list your addresses in the past 5 years

Position

What interests you about the position for which you are applying
What has prepared you for the position for which you are applying?

Employment History

Date of Employment
Company & City/State
Supervisor
Position Held
Reason for Leaving
 
Date of Employment
Company & City/State
Supervisor
Position Held
Reason for Leaving
 
Dates of Employment
Company & City/State
Supervisor
Position Held
Reason for Leaving

Education

Date
School & City/State
Program/Degree
Completed? Yes
No
 
Dates
School & City/State
Program/Degree
Completed? Yes
No

References

Name
Address & City/State
Phone
How long have you known this person?
Has this person agreed to be a reference?
 
Name
Address & City/State
Phone
How long have you known this person?
Has this person agreed to be a reference ?
 
Name
Address & City/State
Phone
How long have you known this person?
Has this person agreed to be a reference?

Child Abuse Prevention

Have you ever been accused physically, sexually, or emotionally abusing a child? Yes
No
If yes, please explain

Authorization

Authorization * I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed about to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant and state law.
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