Application for Employment Personal Information First Name:  * Last Name:  * Email Address: Address:  * City:  * State:  * Zip Code:  * Phone Number:  * Alternate/Cell Phone: Employment Desired Position Applying For: Residential InstructorResidential ManagerRegional Program CoordinatorResidential Program CoordinatorOffice PersonnelOther Administrative Positions Date you can Start (mm/dd/yy) Will you accept: Full-Time Only Part-Time Only Either Ever applied to AGA before? Yes No If yes when? (mm/yy) Referred by: Newspaper Ad Search Engine Friend AGA Employee Other Educational Background (Check highest completed in each level) Grammar School 5 6 7 8 High School 9 10 11 12 College 1 2 3 4 5 6 Name of Last School Attended: Special Training/Skills   Personal References List three persons not related to you whom you have known for at least one year. Name #1: Phone # 1: Address #1 (street address city state zip): Relationship to you #1: Years known #1:   Name #2: Phone #2: Address #2 (street address city statezip): Relationship to you #2: Years known #2:   Name #3: Phone #3: Address #3 (street address city state zip): Relationship to you #3: Years known #3:   Employment History (list three former employers) Company Name and Address #1: Phone #1: Position#1: Name of Supervisor#1: Employed from - to (mm/yy - mm/yy) #1: Hourly pay range #1 (list starting pay and ending pay): Reason for leaving #1:   Company Name and Address #2: Phone #2: Position #2: Name of Supervisor #2: Employed from - to (mm/yy - mm/yy) #2: Hourly pay range #2 (list starting pay and ending pay) Reason for leaving #2:   Company Name and Address #3: Phone #3: Position #3: Name of Supervisor #3: Employed from - to (mm/yy - mm/yy) #3: Hourly pay range #3 (list starting pay and ending pay): Reason for leaving #3:     Applicant Questionnaire What shifts are you interested in working? (check as applicable) Weekends only Evenings Overnights Days only On-call Are there any days or shifts you can not work? What did you like about your old job? Why did you choose this particular line of work? Describe a work-related problem you had to face recently. What procedures did you use to deal with it? Under what kinds of conditions do you do your best work? What strengths and/or assets do you bring to Alpha Group Administrators? What are your weaknesses? Security code:   * Do not enter anything in this field:

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