You are on page 1of 4

Community Youth Ministries

After School Program Employment Application


Todays Date:___________________

Date available to begin work:________________

Name:__________________________________

Contact Phone Number:_______________

Mailing Address:________________________ City:_________________ Zip: ____________


E-mail: ______________________________________________________________________
Last grade completed in school, degree earned or number of units completed:_______________
Are you currently a student? Yes No If yes, what school:__________________________
If applicable, what year in school and what major:_____________________________________
When are you available to work? Please list hours available.
Mondays
Tuesdays
Wednesdays
Thursdays
-

Fridays
-

In what areas are you willing to work?


Reedley
Orange Cove
What grades would you most like to work with?
K-2
3-5
6-8
Are you bilingual?: __________ If yes, in what language?: ______________________________
Do you have medical insurance?
Yes
No
Company Name:________________________ Name of Insured:________________________
Policy Number:_________________________
Do you have any medical conditions which may prevent you from performing tasks on the job?
If so, please describe.
______________________________________________________________________________
______________________________________________________________________________
In case of an emergency during work hours, who should be contacted?
Name
Phone Number
Relationship
1.
2.
Do you have reliable transportation?

Yes

No

Have you ever been in trouble with the law? Yes


No
If yes, please explain:______________________________________________________

Please Answer The Following Questions:


Why do you want to work in an after school program?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Please list specials skills or interests that you would be able to teach students that are both
academic and engaging:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Please describe your past experience working with children:


______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

What characteristics do you have that would be beneficial to our programs?


______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

In your opinion, what is good classroom management?


______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

WORK EXPERIENCE
Please list all previous work experience. Begin with the most recent position held.
Employer:
Position:
Dates Employed:
Reason for leaving:
Supervisor:
Phone Number:
May we contact this employer? Please mark one.
Yes
Responsibilities:

Employer:
Position:
Dates Employed:
Reason for leaving:
Supervisor:
Phone Number:
May we contact this employer? Please mark one.
Yes
Responsibilities:

Employer:
Position:
Dates Employed:
Reason for leaving:
Supervisor:
Phone Number:
May we contact this employer? Please mark one.
Yes
Responsibilities:

No

No

No

Please attach additional sheets if necessary.


REFERENCES
Please list three work references. Please do not list family members.
Name
Phone Number
Relationship to you
1.
2.
3.
Please list one or two character references. Please do not list family members. References may be
former teachers, employers, pastors, or peers.
Name
Phone Number
Relationship to you
1.
2.

Please read the code of conduct below, your signature at the end of this application signifies your
commitment to our code of conduct and that all information provided in this application is true to
the best of your knowledge.
Code of Conduct
1. As an employee of CYM, I will respect the policies and rules of both the organization and the
school site to which I am assigned.
2. As an employee of CYM, I will not participate or promote immoral behavior.
3. As an employee of CYM, I will not promote sex outside of marriage.
4. As an employee of CYM, I will not promote drinking, drug use, or smoking.
5. As an employee of CYM, I will promote peacemaking and never violence for any reason.
6. As an employee of CYM, I will respect others cultural values and beliefs, even if they differ
from my own.
7. As an employee of CYM, I will speak positively to others, affirming each individuals skills and
value.
8. As an employee of CYM, I will not promote the use of profanity or use profanity on campus.
9. As an employee of CYM, I will dress appropriately for work. (Guidelines for dress in employee
handbook.)
10. As an employee of CYM, I will set a positive example for children.
Signature:___________________________________

Date:________________

Thank you for your interest in working with CYM. We look forward to meeting you!

For Your Information


CYM After School programs are not babysitting or latchkey type programs. Only those willing to
invest in the development of youth through teaching leadership, team-building, character education,
and service through fun and exciting activities will be selected. This job may require substantial
planning time. This program is an excellent opportunity for future teachers to gain real world skills
through interaction with students.
All employees will be fingerprinted through the Fresno County Office of Education before they may
begin work. All employees are mandated reporters, required to report abusive situations to their
supervisor so that the proper authorities may be notified.