TENNIS FOR LIFE, INC.

POSITIONS OR JOB
TITLES APPLIED FOR:
________________________
________________________
________________________

1. YOUR NAME IN FULL_________________________________________________________
                     Last               First (Given)             Middle   
a. FEMALE APPLICANT:
    MAIDEN NAME IN FULL_______________________________________________________
 
2. YOUR SOCIAL SECURITY NUMBER___/___/___PHONE (H)____________(W)______________

     E-MAIL_________________________________BEEPER #___________ CELL#____________
 
3. YOUR PRESENT HOME ADDRESS_________________________________________________
                               Street                              Apt.#

                           _________________________________________________
                              City                  State          Zip
 
4. YOUR PERMANENT HOME ADDRESS______________________________________________
                               Street                              Apt.#

                           _________________________________________________
                              City                  State          Zip
 
5. DATE OF BIRTH* ____________________
 
6. ARE YOU A U.S. CITIZEN? ___________________
 
CIRCLE THE HIGHEST GRADE
COMPLETED
1  2  3  4  5  6  7  8  9  10  11  12
COLLEGE
Indicate years credit achieved:
________________
 HIGH SCHOOL EQUIVALENCY
TEST: Date Passed_____________
Awarding Agency______________

TYPE OF SCHOOL
NAME AND LOCATION OF SCHOOL

DATES ATTENDED
From:      To:
mo./yr.    mo./yr.
GRADUATED
TYPE OF DIPLOMA
OR DEGREE
MAJOR OR
MINOR
FIELD OF
STUDY
High School or
Voc. School		  
/             /
Yes          No
    
College or
University		  
/             /
Yes          No
    
*The Age Discrimination in the Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age, but less than 70 years of age.

7. EMPLOYMENT - List ALL your employment, including summer and part time:

NAME AND ADDRESS
OF EMPLOYER
DATES
From:        To:

SALARY
KIND OF
WORK
NAME OF
SUPERVISOR
REASON FOR
LEAVING
Name
Address

Telephone		          
Name
Address

Telephone		          

8. HAVE YOU EVER BEEN DISMISSED OR ASKED TO RESIGN FROM ANY EMPLOYMENT OR

     POSITION YOU HAVE HELD?_____________

          Employer's Name _______________________________Date____________________

          Reason______________________________________________________________________

9. DESCRIBE ANY PHYSICAL DEFECTS OR DISABILITIES YOU HAVE, INCLUDING EXTENT OF
    DEFECTIVE VISION, IF ANY, WITH AND WITHOUT GLASSES AND DEFICIENCIES IN
    COLOR VISION AND HEARING:_________________________________________________

10. LIST ANY ADDITIONAL TRAINING OR EXPERIENCE THAT MIGHT QUALIFY YOU FOR

A POSITION:____________________________________________________________________

_______________________________________________________________________________

         Years playing Tennis _____________                   Years experience teaching:____________

11. IS THERE A PARTICULAR AGE GROUP THAT YOU ARE INTERESTED IN  TEACHING?___________

12. DESCRIBE WHAT YOU CONSIDER TO BE YOUR:

        STRENGTHS________________________________________________________________

        ___________________________________________________________________________

        WEAKNESSES______________________________________________________________

        ___________________________________________________________________________

        FAVORITE PART OF A LESSON___________________________________________

        ___________________________________________________________________________

13. HOW WOULD PEOPLE DESCRIBE YOU?_________________________________________

 _______________________________________________________________________________

Declaration of the applicant:

My signature below certifies that there are no willful misrepresentations or falsification in any of the information on this application. I authorize investigation of all my statements on this application and I understand that should an investigation disclose any misrepresentation or falsification, my application will be rejected, or if already employed, my employment may be terminated. I also understand that I will be considered only for the position I have specified on this application and that three (3) months from the date on this application all consideration for employment may cease unless I notify the Bishop Park Tennis Program that I am still interested in employment.

____________________________________________________________________________________
           DATE                                                                       SIGNATURE OF APPLICANT