Montgomery Village Foundation, 10120 Apple Ridge Road, Montgomery Village, MD 20886
Date * Name * Address * Address 2 City/State/Zip * Email Address Social Security Number * Type number without dashes ex. 'XXXXXXXXX' Telephone * Type number without dashes ex. 'XXXXXXXXXX'
Position Applying for * Second Choice Date Available * If no, please give Date of Birth If yes, please give dates Position(s) If yes, please explain (Record of conviction does not automatically disqualify the applicant from employment consideration.)
Attach Resume .doc, .pdf, .zip files accepted. Please Limit file size to 2Mb If resume is attached, please be sure to include the information from the sections below. If no resume is attached, please complete the sections below.
REFERENCES
Please list three references (do not include people who are related to you).
Name * Address * City/State/Zip * Telephone * Relationship to Applicant *
Name * Address * City/State/Zip * Telephone * Relationship to Applicant *
Name * Address * City/State/Zip * Telephone * Relationship to Applicant *
EDUCATION RECORD
Please include the name and location of school, course of study, highest year completed, graduation date and last degree or diploma.
High School College Graduate Other
PROFESSIONAL LICENSES, REGISTRATIONS AND/OR CERTIFICATIONS
Type If applying for Recreation position, please fill out list of certifications in Recreation section. Date Issued Expiration Date
Type Date Issued Expiration Date
Address RECREATION CERTIFICATIONS
Life Guard Training Expiration Date Montgomery County Pool Operator Expiration Date Community CPR Expiration Date Adult CPR Expiration Date Infant/Child CPR Expiration Date First Aid Expiration Date Small Craft Instructor Expiration Date CPR/FPR Expiration Date Lifeguard Training Instructor Expiration Date Community First Aid & Safety Instructor Expiration Date Water Safety Instructor Expiration Date Head Lifeguarding Expiration Date CPR/FPR Instructor Expiration Date Other Expiration Date
EMPLOYMENT RECORD
List your present and past employment, BEGINNING WITH YOUR MOST RECENT. Please indicate if you were employed under another name.
Employer Address Address 2 City/State/Zip Telephone Supervisor Reason for leaving Hire Date Leave Date Hourly Rate/Salary $ Work Performed
Employer Address Address 2 City/State/Zip Telephone Supervisor Reason for leaving Hire Date Leave Date Hourly Rate/Salary $ Work Performed
Employer Address Address 2 City/State/Zip Telephone Supervisor Reason for leaving Hire Date Leave Date Hourly Rate/Salary $ Work Performed
If you are NOT applying for a position with the Department of Recreation, Parks and Culture, please scroll to the bottom, acknowledge the release information and submit your application.
If you are applying for a job with the Department of Recreation, parks and Culture, please continue to the following sections, acknowledge the release information and submit your application.
DEPARTMENT OF RECREATION, PARKS AND CULTURE
Indicate all position for which you are applying:
Please indicate which activities you have participated in and/or feel comfortable leading.
Participated Creative Drama Group Singing Instrument Playing* Crafts Cooking/Cake Decorating Weaving/Sewing Gymnastics Rollerblading Volleyball Floor/Street Hockey Touch/Flag Football Tennis Softball Basketball Soccer Dance Table Games Ping Pong Low Organized Games Aerobic Exercise Swimming Camping Other* Select multiple options by holding the Ctrl key and clicking all that apply *Please indicate instrument or other activities. Can lead Weaving/Sewing Creative Drama Group Singing Instrument Playing* Crafts Gymnastics Rollerblading Volleyball Floor/Street Hockey Touch/Flag Football Tennis Softball Basketball Soccer Dance Table Games Ping Pong Low Organized Games Aerobic Exercise Swimming Camping Other* Select multiple options by holding the Ctrl key and clicking all that apply * Please indicate instrument or other activities
RELEASE INFORMATION
I hereby authorize Montgomery Village Foundation, Inc., its agents and representatives, to obtain a full disclosure from my previous employer(s) listed above, or provided separately by me, of any information concerning my previous employment, either oral or written. I indemnify and hold harmless any person to whom this request is presented and its agents and employees from and against all claims, damages, losses and expenses arising out of or by reason of complying with this request. A photocopy or facsimile of this authorization will be valid as an original, even though the photocopy or facsimile does not contain an original writing of my signature. The facts set forth in my application for employment are true and complete. I understand that if employed, false statements on this application may be considered sufficient cause for dismissal.
By checking submit, I authorize this application as if it were signed. UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.
I have read and understand this notice. Submit
Cancel
