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Work with WISE

Employment Application

   
1. CONTACT INFORMATION back to top
Note:  Completion of a SSN is optional.  Failure to submit a SSN on this form will not prohibit employment consideration.  A SSN may be required on other forms if hired.
First Name *
Last Name *
Address *
City *
State *
Zip *
Day Phone *
Fax Number
Evening Phone
Email *
Social Security #
   
   
2. POSITION(S) FOR WHICH YOU ARE APPLYING back to top
Please fill out the appropriate information below.
Job Title Location
Job Title Location
Date of Application    
How did you hear about this position?   Newspaper Internet Site Employee Other
Please list name of referral source (i.e., website, newspaper title, employee name, other, etc.)
Are you at least 18 years of age?         Yes No
Are you able to perform the essential functions of the job with or without an accommodation? Yes No
Date Available:
   
   
3. EDUCATION back to top
 Name of School Address of School  Course of Study (Major) Did You Graduate? Degree Received
Yes
No
Yes
No
Yes
No
We require and recognize only degrees, certificates, coursework, academic credits, etc. earned at a college or university accredited by an accrediting association/agency recognized by the U.S. Department of Education.  As required by federal, state, local regulations, laws or regulatory bodies including the No Child Left Behind Act, we require staff members to meet certain criteria, which may include current state certification, acceptable scores on mandatory tests or other documentation that meets the requirements set forth by our organization and/or regulatory bodies for the position applied for and/or held.
   
   
4. SKILLS, competencies, volunteer work, LICENSES AND/OR CERTIFICATES back to top
List any other specific skills, licenses, certificates or volunteer work which may qualify you for the position(s) you seek, e.g. PC skills, teaching certificates, etc. in the space provided. 
Note: Please include states issued, expiration, renewal and/or revocation dates when listing Licenses and/or Certifications.