Step 1 of 2 50% READ HERE BEFORE BEGINNINGThank you for your interest in working at the Center for Leadership Development. This online application is for current college or university students seeking part-time employment ONLY, anyone who does not fit these requirements are encouraged to visit the careers page on the Center for Leadership Development website and review open positions. Student applicants must be available 15-20 hours per week including some evenings and Saturdays. I understand and agree that if I am not a student applicant, I will not be considered for the positions I am applying for on this page:*YesNo Applicant InformationPosition(s) Applying For*Part Time Clerical Assistant (please note, this position works evenings only between 4:30 and 8:30PM)Part Time Program AssistantPart Time Tutor (please note, this position works evenings only between 4:30 and 8:30PM)Preferred Subject to Tutor:*Name* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Are you a graduate of the Center for Leadership Development's Self-Discovery/Career Exploration Project?*YesNoI'm not sureHave you participated in any of the Center for Leadership Development's Programs or Services?*YesNoI'm not sureAre you a 21st Century Scholar?*YesNoI'm not sureAre you authorized to work in the U.S.?*YesNoHave you ever worked at the Center for Leadership Development?*YesNoIf yes, when was your last day of employment?*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Have you ever been convicted of a felony?*YesNoIf yes, explain:*Date Available to Begin Employment*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Availability:*Please indicate the days of the week and times you are available to work at the Center for Leadership Development. Applicants applying for the part time Clerical Assistant and Tutoring positions must be available evenings between 4:30PM and 8:30PM when such services are offered. Add rows as needed to indicate your full availability by clicking the + symbol:Days of the Week (Monday-Saturday)Morning (8:00AM - Noon)Afternoon (Noon-5:00PM)Evening (5:00PM-8:30PM) Higher Education HistoryWhat college or university do you attend?*Location of your college or university:* City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Year in School:*FreshmanSophomoreJuniorSeniorWhat is your major or field of study?*What is your cumulative GPA?*When did you start at this college or university, and when do you expect to graduate?*Year StartedAnticipated Graduation Year Previous Employment - Work ExperiencePlease list your most recent employment first.Employer/Company:*Job Title:*Name of your Supervisor:*Phone Number of your Supervisor:*Address of the Employer/Company:* City State / Province / Region AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Dates Employed:*FromTo Reason for Leaving:Starting Rate of Pay and Ending Rate of Pay*Starting Hourly RateEnding Hourly Rate Please briefly describe your responsibilities:*May we contact this supervisor for a reference?*YesNoMilitary ServiceOnly complete if you have served, or are serving, in a branch of the United States MilitaryBranch:Dates Enlisted:FromTo Rank at Discharge:Type of Discharge:If other than honorable, please explain:ReferencesPlease provide a professional or character reference that is not related to you. Character references may be previous teachers, co-workers, etc. We encourage you to inform your reference that they are being listed prior to us contacting them.Professional or Character Reference Name:* First Last Relationship:*Phone Number:*Disclaimer and SignatureI certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I also understand and agree that my electronic signature is equivalent to my handwritten signature and is legally binding.Signature:* First Last Date Signed and Submitted: MM DD YYYY EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
