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  530-584-2234 Tel

 530-584-2236 Fax                   P.O.Box 1188                      Tahoe City, Ca  


Application For Employment


Name                                                                             D.O.B.      

SS #                                                      Phone #

Address                                                                                         Email      

-Can you provide proof, if hired, that you're eligible to work in the U.S.?                   Yes        No

-Have you ever been convicted of a crime other than a minor traffic incident?           Yes        No

If Yes, please explain.

Have you had a background check?        Yes  No            Have you had a TB Test?      Yes    No

Are you CPR/First Certified?    Yes    No           If Yes, When was your last certification?

What days are you available?                                                    

When are you available to start?

Are you seeking short or long term employment?

Are you interested in “On Call” Substitute, Regular Set Schedule or Both?

Do you have a reliable car to get to work?   Yes   No          Even in the winter months?   Yes     No

Wage expected?                                                  Do you smoke?




# of Years Completed

Grade Avg

Did you Graduate?

Tell us about yourself?

What achievements are you most proud of?

What is your biggest strength?

What is your greatest weakness?

What are your 5 year plans?

Why are you a good candidate for this job?

Please list your present and past employment, starting with the most recent.

Be sure to have the best contact number listed below.


Start/End Dates

Position Held


Phone #

Reason For Leaving


I certify that the information given here is true and complete to the best of my knowledge. I understand that incorrect, misleading or incomplete information may result in immediate termination of employment.

Signed:                                                                                     Date: